HomeMy WebLinkAboutPermit Plumbing 1996-02-21SPRTNGFIELO
BACKFLOU PREVENTION DBVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAPETTY. DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
726-3759
726-3769
CITY OF SPB OFEGO'V
JOB LOCATION:582 SAillrz g
ASSESSORS MAP S:e TAX LOT *: AA,>A
OIJNER:
ADDRESS:
CITY:
PHONE *:
STATB:ZTP
BACKFL0}J PERMIT IS $15.00 + $.ZS ISTATB SURCHARGE) * $.45 (ADMIN. FEE) = $16.20
CONTRACTOR:C,
ADDRESS 2n, Bnv Rq PHONE *:
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CONSTRUCTION CONTRACTORS REGISTRATION *:5 - =^ E EnPTRES. Z^Z^22
BY STGNING THIS PERMIT/APPLICATION, I AGRBE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOLI PREVEMION DEVICE HAS BEEN INSTALLBD AND IS VISIBLE FOR INSPECTION(726-3769>. I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT.
FOR OFTICE USE
DATE 0F APPLICATI0N: 2^2/.
RECEIPT *:
JoB {t, ?ZoZV
TSSUED BY:
2aTOTAL AMOUNT COLLECTED:
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OFFICE:
INSPECTION LINE:
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