HomeMy WebLinkAboutPermit Plumbing 1998-07-211\\\S
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INSPECTI0N LINEz 726-3769
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JOB LOCATION:
ASSESSORS MAP S:I 103 zs3 ?TAX LOT *:700
OVNER:
ADDRESS: ZLs 9 fz^tec-^PHONE #
CITY:STATE: 0/l'ZIP. )?Yoz-
BACKFLOU PERMTT Is $15.00 + $.75 (STATE SURCHARGE) + 9.45 (ADMrN. FEE) = $i6.20
CONTRACTOR: ?I Rool€r-.
ADDRESS: ?O BO*(oft I
CITY: €-u<€x>€STATE: A4-
CONSTRUCTION CONTRACTORS REGISTRATION *Z 1/G 39 I
PHoNE *{gzct_usr,l
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Zfl-u/ "oEXPIRES:
BY SIGNING THIS PERMIT/APPLICATION, I AGRBB TO CALL FOR AN INSPECTION ONCI; THE
BACKFLOV PREVBNTION DEVICE HAS BBBN INSTALLED AND IS VISIBLE FOR INSPECTI(N(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION iS
CORRECT.
FOR OFFICE USB
DATE OF APPLICATION:
RECEIPT {I:
TOTAL AMOUNT COLLECTED:
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ISSUED BY:
JOB II:
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