Loading...
HomeMy WebLinkAboutPermit Plumbing 1998-06-16SPFIHGFIELO . . rrrrrtil',rl' i' Aulhod'd BACKFLOII DEVICE PERMIT APPLICATION 225 FIFTH STREET SPRINGFIELD OR 97477 \S JOB LOCATION: ASSESSORS MAP II 07 OC rAxLor*,5oo O}JNER: ADDRESS:6r PHONE *: CITY:srArE: u /-ZTP,. t>/v7 BAC1(FL9g pERMTT rs $15.00 + $.75 (STATE SIRCHARGE) + $.45 (ADMIN. FEE) = $16'20 OFFICE: ON LINE: 726-3759 726-3769 2../n-:t fizC-CONTRACTOR: \E REGISTRATTOI.I *: PHONE *, A 7A(ADDRESS: CITY: CONSTRUCTION STATB:C/L- FOR OFFICE USE ZTP EXPIRBS: .ru 7h,oo -- BY SIGNING THIS PERMIT/APPLICATION, I AGREB TO CALL FOR AN INSPECTION ONCE TTIE BACKFLO\.I PREVBNTION DEVICE UES SNTN INSTALLED AND IS VISIBLE FOR INSPECTION 7iz.o_ztog). r ALSo srATE THAT ALL TNFORMATTON ON THrS PERMTT/APPLTCATToN rs CORRECT. - /6- / ( DATB OF APPLICATION: ( RECEIPT {I:ISSUBD JOB It: TOTAL AMOUNT COLLECTED: tu o BY:1 nnt4 / I