HomeMy WebLinkAboutPermit Mechanical 1999-04-16SPhTdGFIELD
WOOD STOVE/INSERT INSPECTION
CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION. BUILDING
225 Fifth Sreet
Springfield, Oregon 97 477
CITY OF SPR'NGF'ELD, OREGON
Job Location:
Assessors Map #:
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t1 c \,3q Tax Lot#:6 t1
Preliminary Inspection is $15.00 (prior to installation of insert)
,Yr:i:':*^ellet/Insert Permit is sts'oo + g .zs rt.r" rr.ffie + $.45 Administrative Fee + $10.00
owner: Ka*X Do\".,^.
5 111 ,7d 5{,
City:State: 6 R
Value of Wood Stove/Pellet
Type of Inspection Requested:
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Address I q05 [:=c,,e. AL
City:' cjv-e S u,<t t ,rur.. 6 <
ConstuctionContactorsRegistation#, SZ
Sipature
FOR OFFICE USE
REQUIRED
Phone#: '1 y Ll - I 5t7
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Date
ARY
Date of Application:(.9 Job #:q 2
Total Amount Collected: ,l
#:Issued By:TJ.^
checked for Delinquencies:- checked for Historicar Status:
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