HomeMy WebLinkAboutPermit Plumbing 1997-08-25CITY OF SPR'NGFIELD, OREGO'U
225
SPRINGFIELD OR 97477
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INSPECTION LINE:
726-3759
726-3769
JOB LOCATION:
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OIINER:
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TAX LOT f:Yd
PHONE *:7%.Vad
CITY:STATE:ZI!z
BACKFLOI| PERMIT Is $15.00 + $.75 SURCHARGE) + $.45 (ADMIN. rEE) - $16.20
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PHoNE *: 6o z- trzz
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CONTRACIOR:
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CITY:P-u --1,+*STATE:
CONSTRUCTION .*rffir.*REGISTRATION *:EXPIREST 2l
BY SIGNING THIS PERMIT/APPLICATION, I AGRBB TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-376e).
CORRECT.
STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
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FOR OFFICE USE
DATE OF APPLICATION:2S ET < JoB *: 71 l)bl
RECEIPT *:b)a tK ISSUED BY:
TOTAL AHOI'NT COLLECTED:$/bL(L illtt..,
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