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HomeMy WebLinkAboutPermit Plumbing 1998-07-18f r$\S SPIlltti.iFlELE, 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- o ADDRESS: CITY: 73p hG ft Dtt I PHONE *: CONSTN,UCT CONTRACTORS REGISTRATION #: zw, fff?( EXPIRBS:Z-Zr -E STATE: f 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 CORRI CT. tud n umberforthe Center FOR OFFICE USE I DATE OF A]'PLICATION: RECE-.PT {i I TOTA., AMOJNT COLLECTBD: UED BY: J {t: q tr rt?