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HomeMy WebLinkAboutPermit Plumbing 1996-07-29SPRINGFIELD BACKFLOV PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 FIFTH STREET SPRINGTIELD OR 97477 OFFICE: INSPECTION LINE: 726-3759 726-3769 JOB LOCATION: ASSESSORS MAP *: E S TAX LOT *: 0IINER: S ADDRESSt iR{N. '{L !u PHONE #: CITY:STATE: O zrp: Q'l 18 BACKFLOV PERMIT IS 515.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20 CONTRACTOR: ADDRESS:PHoNE +, lrER-(444 CITY:STATE:zrP: q'l .lo.l CONSTRUCTION CONTRACTORS REGISTRATION *:t-l L q 5 EXPIRES:a- ql BY SIGNING THIS PERMIT/APPLICATION, I AGRBB TO CALL FOR AN INSPECTION ONCE THE BACKFLOW PRBVBNTION DEVICB HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION(726-3769). I ALSO STATE TTIAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT. 1-x-1 c DATE FOR OFFICE USE DATB OF APPLICATION: RECEIPT f,: / ISSUED BY: TOTAL AHOUNT COLLECTED:a 0 {t qaff 1 CITY OF I