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
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f
Tax Lot *: 1
#: Q r< -nut -27 nz*
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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.
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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: