HomeMy WebLinkAboutPermit Plumbing 1994-09-13SPRII{GFIELcD
BACKFLO\,I PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LINE:
726-3759
726-3769
OREGONCITY OF
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JOB LOCATION:
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ADDRESS:o o(( o PHONE #:
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BACKFLOw PERMIT rs $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20
CONTRACTOR:t ?Ge c&es( LArrv 05 c *=)
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CONSTRUCTION CONTRACTORS REGISTRATION *:EXPIRES:
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). r ALSO STATE THAT ALL INFORMATIoN 0N THIS PERMIT/APPLICATToN IS
CORRECT.
FOR OFFICE USB
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DATE OF APPLICATION:
RECEIPT #:
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TOTAL AMOUNT COLLECTED:2o
BY:
JOB *:
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