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HomeMy WebLinkAboutPermit Mechanical 1990-12-12}IOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 0ffice: INSPECTION LINE: 225 Fifth Street Springfield, Oregon 97477 Job Location: Assessors Map #: Ovner: Address: Ci ty: Value of 726-3759 726-3769 Tax Lot S: Phone *: State:zl p: ellet Stove/Insert: Ie approprlate appllance lon is $15.00 (prlor to installation of .lnsert) ov IIet/Insert Permit s1s 00+$1p.00 Iss $1.25 state surcharge.uance Type of Inspection Requested: Contractor: Address:Phone *: Ci ty:State:zi p: Construction Contractors Reglstration #:lres: By signing this permit/applicatlon, I agree to caII for an inspection(s) as required (726-3769>. I state that all informatlon on this application/permit is correct and that I vas provided vith the llood Stove Safety informatlon for vood burnihg app Iiances and prellminary lnspection standards. I also understand that if I am reques t i a Iiminary pection, the vaII covering may be required to be removed. /t;2 Qd ture te FOR- OFFICE USE CITY OF SPR"VGFIELD OREGO'V Prellmina REOUIRED INSPBCTION(S) :UOODSTOVE / PELLET/ INSERT Date of Applicatlon: Y Job *: Total Amoun Receipt $: tCo ed: Checked for Delinquencies: Issued By: Checked for Historical Status: SPRINGFIELD /n nq-IS(I)