HomeMy WebLinkAboutPermit Plumbing 1998-06-24SP]IINGFIELr,
BACKFLOV PREVENTION DEVICB PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRIIiGFIELD OR 97477
OFFICE:
INSPECTTON LINE:
726-37s9
726-3769
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ASSESSORS MAP *:t 7 o73o 3t/
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TAX LOT *:0o3o c:
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crrY: $f fLD STATE: OA z]}z nl q7 \/
WOS((ADMrN. PEE) = $16.20
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PHONE *:
BACKILOI' PERMIT IS $15.00
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CONS:'RUCT]ON CONTRACTORS REGISTRATION #:EXPIRES:
BY S:GNIN(; THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV ]'REVBNTION DEVICE HAS BEBN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). r ALSo STATE THAT ALL INFoRMATI0N 0N THrS PERMIT/APPLICATIoN IS
CORRICT.
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TOTAL AMO]NT COLLECTED:
TSSUED BY:
JOB {I:1(o-'r IDATE OF A?PLICATION:
RECEIPT 1i:
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FOR OFFICE USB