HomeMy WebLinkAboutPermit Plumbing 1996-04-29C'TY OF SPBINGFIELD,OREGO'U
SPRINGFIELO
BACKFLOIJ PREVENTION DBVICE PERMIT APPLICATION
CITY OP SPRINGFIELD
BUILDING .SATETY. DIVI SION
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225 FIFTH STREET
SPRINGFIELD OB 97477
OFFICE:
INSPECTION LINE:
726-3759
726-3769
JOB LOCATION:97
ASSESSORS MAP *:
OUNER:
242
rAX Lor *: f)/OOO
ADDRESS:
CITY:-fu4.
PHONE *:3@STATE:ZIPt
BACKFLOI,I PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADHIN. FEE) = 516.20
CONTRAC-IOR:-kf /Z**tol/olL
/1 PIIONE *:(? ) z<o+/2,
t/rfuuan STATE:tl.ZTPz
ADDRESS:
CITY:
CONSTRUCTION CONTRACTORS REGISTRATION *:&EXPIRES:
BY SIGNING THIS PERHIT/APPLICATION, I AGRBB TO CALL FOR AN INSPBCTION ONCE THE
BACKFLOU PREVENTION DEVICE HAS BEEN INSTALLBD AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSo STATE THAT ALL INFoRMATIoN 0N THrS PERMIT/APPLICATIoN IS
FOR OFTICE SB
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Talres
DATE OF APPLICATION:
RECEIPT ll: 2133L ISSUED BY:4zr,@TOTAL AHOUNT COLLECTED:
JOB II:
qr/74
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