HomeMy WebLinkAboutPermit Plumbing 1994-04-06SPRINGFIELc,
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BACKFLOI,I PREVENTION DEVICE PEBMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING. SAFETY DIVISION
225 Fifth Street
Springfield, Oregon 97 477
0ffi ce:
INSPECTION LINE:
726-3759
7 26-37 69
/D7 b1),/6aJob Location:
Assessors MaP ll:/70 7 2L Tax Lot #:eZOo
Owner:
Address:Phone #ni') -//'
City:State:d( ziP-
Backf'low Permit'is $15.00 + $0.75 State Surcharge
fu3Contractor:
Address:
City:
'a=<
Phone #:?79
State:a<zi p qz /26
Constrddtion Contractors Registration #:SZ Ex pi res:
By signing this perm'i.t/gppf ication, I agt99 to ca'I1 for an inspection once the
backflow prevent!on devitb tras Ueen inst,alled and is vis'ible for inspecll0l
iiz6-ii6g5.- i;iio state that aii information on this application/permit is
correct.
I
ae
FOR OFFICE USE
Oate of Application:
Recei pt *z I L t ?' 1-Issued By:
Total Amount Co] I ected :
6
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Job #: