HomeMy WebLinkAboutPermit Plumbing 1999-02-22SPFI]{GFIELD
BACKFLOU PREVENTION DEVICE PERMIT APPLICATIONCITY OF SPRINGFIELD
BUILDING SAFETY DIVTSION
225 FIFTH STREETSpRINcrIr::.p_On_gZAZZ OFl,rCE: 726_3759
INSPECTI0N ;.INE: 726..3769
JOB LOCATION:L^l CrT
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Notification Center. Those rules are set forth
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CoNSTRUCTIoN CoNTRACTORS REGISTRATION * z /G ? - nxj,rRBS ,_*-Sa_?2
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPEJTION ONCN THEBACKFLO1J PREVENTION DEVICE HAS BEBN INSTALLED EIIO TS VISIBLE FOR INSPECTION(7?'6-3769) ' I ALso STATE THAT ALL INFORMATToN or'r THrS pERMIT/AppLrcATroN rSCORRECT.
BACKFLOI'I PERHTT rs $15.00 + $.75 (srATE suRcHARGE) + $.45 (ADMrN. FEB) = $16.20
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ADDRESS:pHONE *: g 3,F 3A./,f*
CITY:STATE: E,?E ZI.Yz 22r s-2
FOR OFFICE USE
DATE OF /.PPLICATION:'"- ) z-- 1 1
RECEIPT 1,, O3?4 >1
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