HomeMy WebLinkAboutPermit Plumbing 1999-06-24SPB.&;GFIELD
BACKFLOIil PREVENTION DEVICE PERMIT APPLICAT.|ON
CITY OF SPRINGFIELD
ATTE ON
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225 T'IFTH STREET
SPRINGFIELD OR 97
OITFICE:
INSPECT"ON LINE:
726-3759
726-3769
JOB LOCATION:the
ASSESSORS MAP *:
OVNER:
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ADDRESS:
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CONTRACTOR:
ADDRESS:
BACKFLOW PERMIT Is $15.00 + $.mOfiUEE SURCHARGE) + $.45 (A-rMIN. FEE) = $16.20
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CONSTRUCTION CONTRACTORS REGISTRATION *:?rfo 5 EXPTRES:*oo
By SIGNING THIS PERMTT/APPLICATIoN, I AGREE T0 CALL FoR AN ]]'TSPECTToN oNCE THE
BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLBD AND IS VISIBLI. FOR INSPECTION
(726-3769). I ALSo STATB THAT ALL INF0RMATIoN 0N THIS PERMr',|/APPLICATIoN IS
CORRECT.
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FOR OFFICE USE
fi t+, ?Y0 17 /LDATE OF APPLICATION:
j{ 6oRECEIPT II:ISSUED BY:
TOTAL AMOUNT COLLECTED:h
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