HomeMy WebLinkAboutPermit Plumbing 1999-06-01SPRINGFIELO
ATTENTION:Oregon taw requare$ you rri
follow rules adopted by the Oregon Utitity
Notification Center. Those rules are set forth
in OAFI 952-001 -001 0 thropgffifiggtrfiOhuroN DEvrcE pERMTT AppLrcATroN
0090. You may obtain copies of the rules @Ity OF SPRINGFIELD
calling the center. (Note: the tetephomrllDlNc SAFETY DMSION
numberforthe Oregon Utility Notification
22s Ff,EFtu6$Bdh-esz.isqq\. oi;FICET
SPRINGFIELD OR 97477 INSPECITIOII LINE:
726-3759
726-3769
JOB LOCATION:2))? N 3 zA.D
ASsESsoRS MAP *, l7tLtf t'TAX LOT *00ro fr
OUNER:
ADDRESS:
CITY:
>))) AJ 9),a PHONE #:
BACKFL0U PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADHIN. FEE) = $16.20
CONTRACTOR:$
ADDRESS, 3 3 ?S-rl o-zc--,R.t wt rto PHONE *:?y L- P33
CITY: Ca Ml 6 fUv€ srArE: dfL ZTPz
CONSTRUCTION CONTRACTORS REGISTRATION *:2o-Zo 7 P B ,;xprREs:
BY SIGNING THIS PBRMIT/APPLICATION, I AGRBE TO CALL FOR AN INS ]'ECTION ONCE THE
BACKFLOV PREVBNTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE I )R INSPECTION(726-3769). I ALSO STATB TTIAT ALL INFORMATION ON TIIIS PBRMITT-\PPLICATION IS
CORRBCT.
NOTICE:
THISPERMTSHALL EXPIREIFTHE €/-.WORKAIJTHORIZEDUNDERTHISPERMTT,SNOT
ANY 180 DAYPER,OD.
FOR OFFICE USE
s2tr--'j).STATE:
3
TOTAL A},IOUNT COLLECTED:fi.
Jor ff,(fa7S fDATE OF APPLICATION:ff
RECEIPT {}:LIqLL>TSSUED BY:
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