HomeMy WebLinkAboutPermit Plumbing 1996-07-03SPrlINGFIELD
BACKFLOII PRBVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LINE:
726-37s9
726-3769
JOB LOCATION:S+,P
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OIINER:?^^ r,r ie .Yk
ADDRESS:St PHONE #:W=trt-46 q
CITY:I STATB:
BACKFLOU PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20
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ADDRESS:
CITY:STATE:ZTP
CONSTRUCTION CONTRACTORS RBGISTRATION #:EXPIRES:
BY SIGNING THIS PERMIT/APPLICATION, I AGRBE TO CALL FOR AN INSPECTION ONCE THE
BACKFLOV PREVBNTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION(726-3769). I ALSO STATE THAT ALL INTORMATION ON THIS PERMIT/APPLICATION IS
CORRECT.
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T'OR OFFICE USB
DATE OF APPLICATION:7- 3 -7 tO
RECEIPT II:q rssuED BY: l-'r . nnach dclo
JOB II
TOTAL AMOUNT
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DATE
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