HomeMy WebLinkAboutPermit Plumbing 1998-07-18f
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OIIFICE:
INSPECTTON LINE:
726-37s9
726-3769
BACKFLOW PREVENTION DEVICB PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFBTY DIVISION
225 F;FTH STREET
SPRIN,;FIELI 0R 97477
JOB LCCATION:t4)c
ASSES]ORS :,IAP #:TAX LOT fi:
OVNER:
ADDRESS:_.PHONE #:
CITY:STATE:ZIP:.?z(4
BAcKF:0w l'lRMrr rs $15.00 + $.75 (srATE ST.JRCHARGE) + g.45 (ADMrN. FEE) = $16.20
CONTRACTOIi:Sr.T -r.ftur,c@1-
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ADDRESS:
CITY:
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CONSTN,UCT CONTRACTORS REGISTRATION #:
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EXPIRBS:Z-Zr -E
STATE:
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BY S]GNINC THIS PERMIT/APPLICATION I AGRBB TO CALL FOR AN INSPECTION ONCE TTIEBACKTLOV i'R,BVBNTION DEVICE HAS BEBN INSTALLED AND IS VISIBLE FOR INSPECTION(726*3769': . I ALS0 STATB APPLICATION IS
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FOR OFFICE USE
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DATE OF A]'PLICATION:
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TOTA., AMOJNT COLLECTBD:
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