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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: ( u, JoB # , q10 tf? o a L 0