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HomeMy WebLinkAboutPermit Mechanical 1990-11-21ITOOD STOYE/INSERT_INSPECTION APPLICATIONCITY OF SPRTNGFIEID BUTLDING SAFETY DTVTSTON SPFTNGF!ELD Office: TNSPECTION LINE: 225 Fifth StreetSpringfield, Oregon 97477 Job Location:4 dea"th Assessors Hap #,vt- tt L Owner: Address:,O ZL Ci ty: Value of lIood St 726-3759 726-3769 -LL ,r^ d D f Tax Lot *: 1 #: Q r< -nut -27 nz* t-tjrg{^0>Tsa- 3q 38ztp: L) Phone State:{*o36 1+rs)-AC- (please clrcle appropr Prellminary ectlon lIood Stov Type of fnspection Requested: Con t rac tor: Stove/Insert iate applian ee is_$15.00 (prior to installation of .lnsert)rt Permit is 915.00 + $10.00 rssuance + $1.15 "t"t" surcharge. Address. lV, +S We/y{r b frl Phone S:D3 33 Ci ty:State: O R-zi p: construction contractors Reglstration #, {65O5 nxpires, /0,28, A/ By signing this permit/applicatlon, I agrce to call for an inspection(s) as required(726'3769). I state that all informatlon on thls applicatlon./permit is'corr"ci andthat I was provided wlth the llood Stove Safety information for vood burnihgappliances and prellmlnary lnspection standards. I also understand that ii I amrequesting a preliminary inspectlon, the wali covering may be requlred to be removed. o X fr/*n &oattt'&{l . /r, Ft) Sl1ihature REQUIRED TNSPECTT0N(S) : Date of Application: Total Amount Collected: FOR. OFPICE USE INSERT Issued By: Date Job #:q / PRBLIMINARY Receipt *:\ Checked for Delinquencies:Checked for Historical Status: