HomeMy WebLinkAboutPermit Plumbing 1999-03-01SPRIlvGT.'IELC,
BACKFLOV PREVENTION DEVICE PERMIT APPLICATIO ]
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIE::,D OR 97477
0
INSPBCTICN
FFICE
LINE
726-37s9
?26 3769
JOB LOCATION:q ...u-
ASSESSORS MAP T:I 10<.\rAXLor{:2t3OO(tt
OIINER:
ADDRESS:
CITY:
BACKFLOU PERMIT IS $15.00 + $.ZS 1
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ADDRESS:
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CONSTRUCTION CONTRACTORS
BY SIGNING THIS PERHIT/APPLICATION,
BACKFLOI*' PREVENTION DEVICE HAS BEEN(.726-3769). r ALSo STATE THAT ALL
CORRECT.
DATE OF /.PPLICATION:
RECEIPT I,:
I AGREB
INFORMATION ON
PHONE
\AN
$ 16.20
AN INI;PECTION ONCII TIIE
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STATE:1
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REGISTRATIoN S, l-LO\)o1 EXPIRBS: J-\ E- C,O
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FOR OFFICE USE
TOTAL AH(IUNT COLLECTED:
TSSUED BY:
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INSPECTION
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