HomeMy WebLinkAboutPermit Mechanical 1989-11-29ct TY OF SPR OREGON
?25 Fifth StreetSpringfield, 0regon gl4ll
SP,ITi.GFIELD
Tax Lot #:
Office:
INSPECTION LINE:
t,llOOD STOVE/INSERT INSPECTION APPLICATIONCITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
7?6-3759
726-3769
Job Location:
Assess Map #:a
Owner:
Addres s :
City:State:
Value of l,/o d e(please c cle pr a app ance
i5.
Type of Inspection Requested:
Contractor:
Addres s :
(-
Phone #:
Phone #:
t-
Zi p:1
P.rel iminary Inspection .is
$Wood Stove/Inseit permit is
00 (prior to inst5.00 + $0.75 stat
allation of insert)e surcharge
City:
Cons t
By si
requ i
permi
State:
ruction C ractors Registration #:
gni ng
(
this rmit/app'lication I agree to cal I forpe
69
t
Zi p:
Ex pi res :
an inspection(s) as
on this application/
Stove Safety information
tandards.
// ' 7'i -Y"/
Date
red 726-37 I also state that all informationt is correct and that I was provided with the Woodford burning applianc and prelim'inary inspection s
/((
a ure
FOR OFFICE USE
nser
RE QU I RED I NS PECTI 0N (S ) : I,l00D TOVE L./' PRELIMINARY v/'
Date of Application:Job #:
Total Amount Collected:
Receipt #:I ssued By :)T'
Checked for Del inquenc'ies:"/ Checked for Historica'l Status , t/
@
nq 453
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