HomeMy WebLinkAboutPermit Plumbing 1999-03-30,F
SP]lINGT:IELO
BACKFLOU PREVENTION DEVICE PERHIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET_.__ 3FFICE: 726-3759
JoB LoCATIoN: Z{ 8 3 /fTk 5T
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CONSTRUCTION CONTRACTORS REGIS
BY SIGNING THIS PERHIT/APPLICAT
BACKFLOII, PREVENTION DBVICE HAS(7?.6-3769). I ALSo STATE THAT
CORRECT.
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OIINER:
ADDRESS: Z{8 }N /f4 sr"
CITY:
BACKFLOIJ PERHIT
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ADDRESS: t?O t4*, x 3KL
\F $E
#i'"'fl
STATE: O ft-i..\\?ur1ZI}t
-,i "
IS $15.00 + S.75 (STATE SURCHARGE) +'$.AS (eoxrH. FEE) = $16.20
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PHONE *:o
STATE: O&ZI!z
DATE OF /.PPLICATION:
FOR OFFICE USE
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RECETPT I':
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by the You 1s
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EXPIRBS:
ONCIi THE
INSPECTION
CATION IS
TOTAL AH(IUNT COLLECTED:
ISSUED BY:
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