HomeMy WebLinkAboutPermit Plumbing 1998-09-24NOTICE:
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SPRII{GF!ELE,
ON DEVICE PERMIT APPLICATION
OF SPRINGFIELD
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OITFICE:
INSPECTION LINE:
726-3759
726.-3769
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OIINER:N{o>',
ADDRESS:7 s pHoNE #: 7t7' c{ fo b
CITY:('STATE, OIU zrPt ?7({a77
BACKFLOH PERMTT IS $15.00 + S.75 (STATE SIRCHARGE) + 9.45 (ADMrN. pEE) = $16.20
coNTRACTolt: /t"t twl'l
ADDRESS:
CITY:
PHONB *:
STATE:ZIPt
CONSTRUCT:TON CONTRACTORS REGISTRATION *:EXPIRES:
BY SIGNIN|] THIS PERHIT/APPLICATION, I AGRBE TO CALL FoR AN INSPBCTIoN oNcji THE
BACKPLOIJ PREVENTION DEVICE HAS BEBN INSTALLED AND IS VISIBLE FOR INSPECTI( N(726-3769). r ALSo Sr
CORRECT.
FOR OFFICE USE
DATE OF /.PPLICATION:Lt(
RECEIPT I:03rrLr
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TSSUED BY:
TOTAL AH(IUNT COLLECTED:16. zo
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/APPLICATION IS