HomeMy WebLinkAboutPermit Plumbing 1997-10-22SPFIHGFIELO
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DIVISION
IT APPLICATION
OFFICET
INSPECTION LIM:225 FITTH STREET 726-3759
726-3769SPRINGFIELD OR 9
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JOB LOCATION:ho/
AssEssoRs MAP *: llozS LIruAX Lor il:
ck 479
CITY OF SPF OFEGO'U
O1INER:
ADDRESS:
CITY:
q47 R s+PH0NE S: '746 ^ 7o I 3
{o tz titt a -Q ,*'l*)STATE: Ol/L zIPt q7q77T
BACKFLOIJ PERMIT IS S15.00 + $.75 (STATE suRcHARGE) + $.45 (ADMIN. FEE) = $15.20
CONTRACTOR:
ADDRESS:PHONE *:
CITY:STATE:ZIP:
CONSTRUCTION CONTRACTORS REGISTRATION *:EXPIRES:
* G, n Tt g-*A i n 7 . t-r'rs(, a-:fd-?--r +1/"1- P u-r*^; 1 Cs,'-t zac-fT-'z-'
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL rOR Al.l INSPECTION ONCB TIIE
BACKFLOII PREVENTION DEVICE HAS BEEN INSTALLED AI{D IS VISIBLE FOR INSPECTION
(726-3769), I ALSo STATE THAT ALL TNFoRMATToN 0N THrS PERMIT/APPLICATION IS
CORRECT.
SIGNATURE
POR OFFICE USB
: DATB oF AppLrcATroN: lo -.]J - I -7 JoB f: q 1 t54
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RECETPT *z it -7Zo ? TSSUED By:{,vJ
TOTAL AI{O['NT COLLECTBD:lLo- >g-
7
I
4-ca*-c<tr n L+ { d* L-"-;**}J a-f ,l-aS = L'^-.-