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HomeMy WebLinkAboutPermit Plumbing 1999-08-05C'TY OF OBEGO'U SPRII{GF!ELO BACKFLOTT PREVEMION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: INSPECTION LINE: 726-37s9 726-3769 JOB LOCATION: ASSESSoRS MAP *z l70??L 4/ada ()() OI.INER: n,awre quires you to Utility in OAB 952-001 nter Those rules are Set forth ln number the +$.45 (ADMIN. FEE) =$16.50 PHONE *: 952-001_ the rules byADDRESS: CITY: ANYl BACKFLOII PERMIT S 1 THIS PERIOD.5.00 + 1.05 (STATE suRcHARcE) {CONTRACTOR: ADDRESS: CTTY:-€STNIEz ffi,Z]Pz Tzqot CONSTRUCTION BY SIGNING THIS PERMIT/APPLICATION, I AGRBE TO CALL FOR AN INSPECTION ONCE THE BACKFLOV PREVENTION DEVICE HAS BEEN TNSTALLED AND IS VISIBLE TOR INSPECTION(726.3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. R- q f1 DA:TE FOR OFFICE USE REGrsrRArroN # , L.# 1-5o2r/8'.7 nxprRES:1 DATE OF APPLICATION: 'RECETPT *:Blfr5V TSSUED BY: TOTAL AMOI'NT COLLECTED: q o t *: ?Q tog 2 l? qt: C/r,n ^,,8t 0*i