HomeMy WebLinkAboutPermit Plumbing 1999-06-24 (2)t>\
CITY OF SPF OFEGO'U
BACKFLOII PREVENTION DEVICE PERMIT APPLICATJ.ON
CITY OF SPRINGFIELD. BUILDING SAFETY DIVISION
SPRI}'GFIELO
OI.'FICE:
INSPECT:ON LINE:
726-3759
726-3769
225 FIFTH STREET
SPRINGFIELD OR 97477
JOB LOCATION:
ASSESSORS MAP *, ! ?3
CONTRAGTOR:
ADDRESS:
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OIJNER:80
ADDRESS:PHONE *:
CITY:STATE:a?*ZTP f vrZ-
BACKFLOI{ PERMIT IS $tS.00 + $.7S 1514T8 SURCHARGE) + $.45 (AtrMIN. FEE) = 916.20
FOR
PHoNE +,?*r'agg/
CITY:srArE: 4Zl/a ZTPt
coNSTRUcrroN coNTRAcroRS REGrsrRATroN #, ?lUai EXPIRBS , /- d
BY SIGNING THIS PERMIT/APPLICATI CALL FOR AN ]].ISPECTION ONCE THE
BACKFLOI,I PREVENTION DEVICE HAS FOR INSPECTION(726-3769). r ALSo STATE rHA S
CORRECT
UNDER
FOR OTFICE USB
DATE OF APPLICATION:
RBCEIPT *. O 9% O O TSSUED BY:
TOTAL AHOUNT COLLECTED:7{ z"
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