HomeMy WebLinkAboutPermit Plumbing 1997-08-07--\
SPFINGFIELO
ON DEVICE PERI'IIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
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JOB LOCATION:
ASSESSORS MAP +:
OFFICE z7
INSPECTION LINE:
TAX LOT +!48o
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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
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..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:
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