HomeMy WebLinkAboutPermit Plumbing 1996-09-25SPNINGI=IELO
BACKFLOIil PREVENTION DEVICE PEIMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTIT STREET OFFICE: 726-3759
JOB LOCATI oN: )/-lq qzil {n
ASSBSSORS UAP II:*TAx LOT *z cDe{aa
Qrt
CITY OF
OlINER , {;tuu
ADDRESS: 7Z/q nrt fr.PHONE $:
STATB:ZIPzCITY:
BAct(FLou pERMrr rs $15.00 + 9.75 (STATE STRCHARGE) + S.45 (AD},!IN. FEE) = $16.20
CONTRACTOR:
ADDRESS:PHONE It:
.TTY. STATB: ZIP:var a.
CONSTRUCTION CONTRACTORS REGISTRATION *:EXPIRES
BY SIGNING TIIIS PBRMIT/APPLICATION, I AGRBB TO CALL FOR AN INSPECTION ONCE TIIE
BACKFLOU PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSo STATE TIIAT ALL INFoRMATIoN 0N TIIIS PERIIT/APPLICATI0N IS
CORRECT.
7
J
FOR OFFICE USB
DATE OF APPLICATI0N: d"-2,
RECEIPT II z 23222--ISSUED BYJ
2e*TOTAL AMOUNT COLLBCTED:
JoB lt, 2€,,/299-
7qz"///3