HomeMy WebLinkAboutPermit Plumbing 1998-08-31SPBINGFIELD
BACKFLOL' PREVBNTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SATETY DIVISION
%
225 FIFTH STREBT
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LINE:
726-3759
726-.3769
JOB LOCATION:330 b
ASSESSORS MAP *:o3
OIINER:
ADDRESS:Dlb
CITY:
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BACKFLOIJ PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADHIN. FEB) = $r.6.20
CONTRACTOR:
ADDRESS:PHONE *:
CITY:STATE:ZTP
CONSTRUCTION CONTRACTORS REGISTRATION #:EXPIRES:
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOU PREVENTION DEVICE HAS BBEN INSTALLED AND IS VISIBLE FOR INSPBCTION(726-3769). I ALSO STATE THAT ALL INFOR},IATION ON THIS PERMIT/APPLICATION TS
CORRECT.
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DATE OF APPLICATION:
RECETPT *:
JOB *:'tlrt,t c--I ?Nv
ISSIJED BY:
oTOTAL AI.IOUNT COLLECTED:
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