HomeMy WebLinkAboutPermit Plumbing 1994-05-09SPrlTNGFTELO
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INSPECTION LINE:
726-3759
7 ?6-37 69
%
BACKFLOW PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING' SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97 477
//</?Job Location:
Assessors MaP #:
0wner:
Address:
r. i rrr . State :urvJ. .
Backf'low Permit is $15.00 + $0.75 State Surcharge
Contractor:c,'J
Address:<o
City:State:
Constru'ltion Contractors Registration #:3o
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FOR OFFICE USE
Date of ApPlication:a -r4
Tax Lot #:
Phone #:7/6-B<2
Phone #:7 z/a/ -
Ex pires:
By sign.ing this permit/application, I agr99 to call for an'inspection once the
backsow p.er.nrli;;;;i[[ h;; b;;; initaued and is v'isib'te ror inspection
(726-3769). f aiso i[ate tfrat aii] iniormation on this app'lication/permit is
correct.
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Receipt tlt / 2ALZ- Issued BY:
Total Amount Collected:/a?"
Job #:
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o,4 z:P:7747?
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