HomeMy WebLinkAboutPermit Plumbing 1999-08-27SPRIHGFIELD
BACKFLOII PREVEMION DEVICE PERMIT APPLICATIOI{
CITY OF SPRINGFIELD
BUILDING SATETY DIVISION
%
225 FIFTH STREET
SPRINGFIELD OR 97477
JOB LOCATfON: &l ft-
ASSESSORS MAP *:
OIJNER: YlZ TI+.
OFFICE:
CTION LINE:
726-3759
726-3769
i1
TAX LOT #:
ADDRESS:
CITY:
tG85 Yottxcn PHONE *:
3po iilzEtv )D STATE: AZ ztP
BACKFL0IJ PERMIT IS $15.00 + 1.05 (STATE SLRCHARGE) + $.45 (ADuIN. FEE) =916.50
CONTRACTOR:
ADDRBSS:
CTTY:
?*n*R d)EA t PHoNE * 4Ci-/*.4
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5"
CoNSTRUCTTON CONTRACiOnS REGTSTRATTON #, |2.f,.2c, Gtc-) nxpTRESt l,L/qq
BY SIGNING THIS PERMIT/APPLI cATroN,
BACKFLOU PREVENTION DEVI CE HAS BEEN(726-3769). r ALS0 SrAr E THAT ALL I
CORRECT
STATE: OR-
No I/CE;
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DATE OF APPLICATION:
RECEIPT #:
POR OFFICE USE
IF
/s NOT Dhone
lity Notificatiorfica
TOTAL AMOUNT COLLECTED:
TSSUED BY:
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1
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INSPECTION ONCE THE
VISIBLE FOR INSPECTION
S PERMIT /APPLICATTON IS
lri iFNr ION:Urego rr law requires you to
follow rules adopted by the Oregon Utility
Jotification Center Those rules are set forth
in OAB 952-001-0Ol 0
obtain
calling the center. (
numberforthe
Center is 1-800-332t-?A441.
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