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HomeMy WebLinkAboutPermit Plumbing 1998-09-24NOTICE: TH r s p E R M rr sHALL Expftff IPtfH rf6H[3lll' SPRII{GF!ELE, ON DEVICE PERMIT APPLICATION OF SPRINGFIELD AUTHoHTZED UNDEH TH|S pERMty;g lffiLDrNG sAFEry DrvrsroN qfl{u FItFtrr QrfdfidtrBAN DoN ED F0 H AUmim0[E]mmBn97477 OITFICE: INSPECTION LINE: 726-3759 726.-3769 aut JOB LOCAT.I,ON:/i-7 S I ASSEssoRS MAP *, l7oiTs\t rAX Lor *: 087 oo 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 ?t TSSUED BY: TOTAL AH(IUNT COLLECTED:16. zo ru."/ JoB {r,fil\ 1l /APPLICATION IS