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HomeMy WebLinkAboutPermit Plumbing 1997-11-04SPFINGFIELE, % BACKFLOW PREVBNTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD 3Ui1a1'-;o+ *vet- , BUTLDTNG sAFETY DrvrsroN 225 FrFTH sTRBET a 6r-kT,rhn r a-r- OFFrcE: SPRINGFIELD OR 97477 INSPBCTION LINE: 726-3759 726-3769 JOB LOCATION: Co (2;,r*," b!.-r"- ASSESSORS MAP IIz OOOoc:el oO O.1 O TAX LOT *: OVNER: ADDRESS: .rK, +.<+ 6 STATE:o dlE PHONE #:a vt/-2/ 6 0 ZTP z ?'7 Y77CITY: CONTRACTOR: 't */d a/?. BACI(FLO\.I PERMIT IS $15.00 + $.75 (STATE SURCIIARGE) + $.45 (ADMIN. FEE) = $16.20 I ADDRESS 2 ? {- 1z t 8G*,*. 6*tr<, Z.-,t PHONB *:1.r.r=.7 z t,r' CIrY: 1/<.-tA-a STATE: Or,( e ,zTPz 7Z zttT coNSTRUcTIoN coNTRAcToRs REGISTRATION +z I I 67 7 EXPIRES: 1- ?a ^7r BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE TIIE BACKFLOV PREVBNTION DEVICB (726-3769). r ALS0 SrATI CORRECT. 11 t2 22- DATE FOR OFFICE USE IS VISIBLE FOR INSPECTION TIIIS PERMIT/APPLICATION IS 4 Nq-"n"al'v,-DATE OF APPLTCATION: RECEIPT II: J )1 SSUED BY: TOTAL AHOUNT COLLECTED:Sl tr ao JOB {I:58 NOT Fon City of St,r'ini;f :i.eId ea5 Fift,h Str'eet $pr'rngfiel.d, Ct 3?477 ( 503 ) 7eb-3753 Tr.ansact ion nrlnrber' ilP'739t: Noveurher'131 1937 3:00 At'l Reeeived fr.$m; RANflALi.. HIiNTER Cont,r.act,,/0rrrn ; CIO RIUER GL.EN Address: ?52?h $TRAl.lFifir"iY LANE Cit,y; UENETA $t : tlR IiP: ?7487 -Br.ii. lding- Job *r 371581 Ilescr'iFtion Flrln'bing Totai: Anrt, Rere i ved I Check *: 5t77/517 Fee 16.e0 t[. e0 LE.CLr Lnet:H Thank yor:1 ll;:yE lri .