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HomeMy WebLinkAboutPermit Plumbing 1997-08-08roR SPllINGFIELE, OFFICE: INSPBCTION LINE: 726-3759 726-3769 PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFBTY DIVISION 225 FIFTH STREET SPRINGFIELD OR 97477 JOB LOCATION:/ / {/ Seq-^o--, +b-*; l-rt-/ ASSESSORS MAP lt:W V &T*;lacs OIINER: ADDF.ESSI//c// €a*-t#PHoNE *, 2/Z -3tr CITY:STATE: t*,.-?ZIP z 72772-v-- JT BACIGL0LI PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20 CONTRACTOR: ADDRESS:PHONB *: CITY:STATE:ZIPz CONSTRUCTTON CONTRACTORS REGISTRATION *:EXPIRES: BY SIGNING THIS PERMIT/APPLICATION, I AGRBB TO CALL FOR AN INSPBCTION ONCE TTIE BACKFLOV PREVBNTION DEVICE HAS BEEN INSTALLED AND IS VISIBLB FOR INSPECTION (726-3769). I ALSo STATE TrrAT ALL TNFoRMATIoN 0N THIS PERMIT/APPLICATIoN IS CORRECT. FOR OFFICE USB TOTAL AMOUNT COLLECTED: ISSUED BY: . JOB {}:Qirzc t1TDATE OF APPLICATION: RECEIPT {}:21