HomeMy WebLinkAboutPermit Mechanical 1990-01-22CITY OF SPF'A'GFIELD, OBEGO'V
\.IOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION ltl.6b
225 Flfth Street
Springfield, 0regon 97 477
Office:
INSPECTION LINE:
726-3759
7 26-37 69
Job Location:
Assessors Map #:rl
Owner:
A}h,
Tax Lot #:
Address : lq.Pl N /f )h Phone #:- Add€
City:
Value of Wood Stove
(p'lease cjrcle
Prelim'inary Inspection is $15.00 (prior
Wood Stove/Insert Permit is $15.00 + $0.
2 / 0 0. o0 fd,u-r
^ffi,<-priate appl iance)
State fr ,Zi p ,fzqLz
to
75
installation of insert)state surcharge
Type of Inspection Requestedt
Contractor:
Addres s :Phone #:
City:State: P,
Construction Contractors Reg istration #:Ex p'ires :
gna e a e
By sjqn'inq this permit/app'l'icat'ion, I agree to,call for an inspectign(s).as.
rtqrii.o itiO-*'Ail. t iiso state'that-all information on this app'lication/..
permit is correct ind that I was provided with the Wood Stove Safety'information
for wood burning app'liances and preliminary inspection standards.
Zi p:f 7za ,/bl
I pnELIMiNARY t./-''ff^
REQUIRED INSPECTION (S ) :
Date of Appl i cat'ion :D
Total Amount Collected:5,7{
Rece'ipt #:6 Issued By:
?
FOR OFFICE USE
f
Job #:D
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Checked for Del inquenc'ies:Checked for Historical Status:-
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