HomeMy WebLinkAboutPermit Mechanical 1990-01-12CITY OF SPRINGFIELD, OREGO'V
SPRI]I|GFIELEI
I,IOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springf ie'ld, 0regon 97477
Job Location:
Assessors Ma #
Owner:
Address:
City:
Value
(pl eas c
Office:
INSPECTION LINE:
726-3759
726-3769
q Tax Lot #:
Phone #:
State:
Insert:rcle appro pr a app ance
Zi p:
Preliminary Inspection is $15.00
tlood Stove/Insert Permit is $15.0
(
0 + $0.75 s ate surchar
prior to installation rt )i nseof
ge
Type of Ins
Contractor:
Addres s :
pect i on ted
City:_ State:Z1 p:
Construction Contractors Registration #: Ex pi res :
By signing this permit
required (726-3769).
pe
fo
rmit is correct an d
I 1 iminary'inspection standards.burn ap an
gna ur e
FOR OFFICE USE
REQUIRED INSPECTION (S) :u/PREL IM I NARY
Date of Application:
Total Amount Collected:
Rece i p t#: t5?b+Issued By:
/ appIal
that
Phone #:
licat'ion, I agree to call for an inspection(s) as
so state that all information on this application/I was provided with the Wood Stove Safety informationrnc
t
Checked for Del inquencies:hecked for Historical Status:
Job #:
I