HomeMy WebLinkAboutPermit Plumbing 1997-10-23l/-\
CITY OF SPR OREGO'V
NOTIGE:
"'S
PENN,iIT SHALL EXPIRE IFTHE WORK
AuTHoRIzED UNDEB TH&Rfrfff,t}lSN9ilumroN DEvrcE PERMTT APP
coMMENcEDoRIsABANDoNE"0*rurtHJ*.otfrT#IxTrrt&0,
AI.IY 180 DAY PERIOD
225 FIFTH STREET
SPRINGTIBLD OR 97477 IN
SPII!'{GFIELD
LICATION
OFFICE:
ISPECTION LINB:
726-3759
726-3769
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JOB LOCATION: iq tttirblel"Y Pl*c s R;v"C;cll av 11y7a5
ASsEssoRs MAP *: f1 O 3 3 '+
S,+rJnn 9 (o,*,r rl C"€li V
rAx Lor x, Co6l?
OIINER:
ADDRESS:
CITY:. (;u fJ STATE:0K
I Y1 | wi nb(c.l'u Pltcc Puorlg s: 12(- f f {C
zrpz 17<t17
BACKFLOU PERI,IIT IS $15.00 + S.75 (STATE SURCHARGE) + $.45 (ADHIN. FEE) = $16.20
I
ADDRESS:PHONE f,:
CITY:STATE:ZTP
CONSTRUCTION STRATION *:EXPIRES:
BY SI THrS PERMTT/APPLTCATToN,I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOU PREVEMION DEVICE HAS BEEN INSTALLED AND IS VISIBLE TOR INSPECTION
(726-3769), I ALSo STATE THAT ALL TNFoRMATIoN 0N THIS PERMIT/APPLICATIoN IS
CORRECT.
23 ?7
FOR OFFICE USE
7o
JoB s ,11 t 5q 4fDATE OT APPLICATION:
RECEIPT S: D>7
to /z t/q I
/S ISSUED BY:
TOTAL AMOI'NT COLLECTED
A
(