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HomeMy WebLinkAboutPermit Plumbing 1997-08-07--\ SPFINGFIELO ON DEVICE PERI'IIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 0n \( €s 1\\\g 225 \QF 477 JOB LOCATION: ASSESSORS MAP +: OFFICE z7 INSPECTION LINE: TAX LOT +!48o *h * 13r+T S t/ )!J a I aa ONcIrvOF O\INER:EDt lArlZ\L. ADDRESS: I +h PIIONE *: S PAIN G(re z-D STATE:ZI?z 914t lCITY: BACKFLo\JPERMITIss15.00+$.75(STATEst,RcHARGE)+$.45(ADMIN.FEE)=s16.20 CONTRACTOR:m EtrD LA 3e-avr c.^€-<, ADDRESS: \J €PHONE *:(-'qhzas .94o3 cIrY: a%t Crtrr EZT\STATE:o{L ZTP..q)q'78 ..CONSTRUCTION CONTRACTORS REGISTRATION *:bbqf V ^':v,EXPIRES: BY SIGNING THIS PERMIT/APPLICATION, I AGRBB TO CALL FOR AN INSPECTION ONCE THE BACKFLOV PREVENTION DEVICE HAS BEBN INSTALLBD AND IS VISIBLE FOR INSPECTION (726-3769). r ALSo STATE THAT ALL INFoRMATIoN 0N THIS PERMIT/APPLTCATIoN IS CORRBCT. FOR OFFICE USE DATE OF APPLICATION: RBCEIPT I}:D)102_r TOTAL AMOUNT COLLECTED: ISSUED BY: , JoB {t: /r(-'-- O /)flh (sqh'74b- 58a/ DK T L