HomeMy WebLinkAboutPermit Plumbing 1998-01-26C'TY
SPITINGTIELO
BACKFLOV PRDVENTIOI.I DEVICB PERMIT APPLICATION
CITY OF SPRINGFIELD
DUILDING SAPETY DTVISION
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225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE:
INSPBCTION LINE:
726-3759
726-3769
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BACI(FLOV PERMIT IS $15.00 + $.ZS 1
TAX LOT II:
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) + $.45 (ADMIN. IiEE) = $16.20
JOB LOCATTON:
ASSESSORS MAP I}:
OUNER:
ADDRESS:
CITY:
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CONSTRUCTTON CONTTIACTORS REGISTRATION {I:
BY SIGNING TUIS PIRMIT/APPLICATIoN, I AGREE T0 CALL FoR AN IN
BACKFLOV PREVENTION DEVICE IIAS BDEN INSTALLED AND IS VISIBLE
STATE TIIAT ALL INFORMATION ON TIIIS PERMIT
SPECTION ONCE TIID
FOR INSPECTION
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CORI(ECT.
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FOR OFIITCE USE
DATE OT APPLICATION:
RECEIPT {[:
TOTAL AMOUNT COLLBCTED:
ISSUED BY:
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JOD II: