HomeMy WebLinkAboutPermit Plumbing 1999-04-12SP]IINGFIELE,
BACKFLOIJ PREVEMION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAPETT DIVISION
225 FIFTH STREET_._- gFFICE: 726_3759
JOB LOCATION:llel{r4z/.*,tz 6/v'/,6a/-7t4/ 4lilld /Ps
ASSESSORS MAP *:>{3
OIJNER:
ADDRESS:/0K flo/"hare Blvd.
TAX LOT *:06Loo
PHoNE *: 7'// -016{
CITY:I STATE:ZTPz 77
BACKFLOW PBRMIT IS $15.00 + S.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20
coNrRApTOPi:
ADDRESS:
CITY:
3 zr
STATE: OIL
coNSTRUCTToN coNTRACTORS REcISTRATI0N *: 00 Lr 4ot L
BY SIGNING THIS PERMIT/APP
PHONE *:
ZTPZ Q 7T"5
EXPIRES:
BACKFLOV PREVENTION DEVICE HAS(126-3169). r ALso srarr rHai
CORRECT.
ONCI THE
INSPECTION
CATION IS
in 952-001 -001 0 through OAR 952.001 -
u n copies of the rules by
center. (Note: the telephone
forthe Oregon Utility
center is 1 -800-332-2U4)/2-
FOR OFFTCE USE
DATE OF /.PPLICATION:
REcEIPT 1,r 033{f )TSSUED BY:
TOTAL AMOUNT COLLECTED:
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JoB # , q10 tf? o
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