HomeMy WebLinkAboutPermit Plumbing 1998-01-26aC'TY
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BACKFLOU PREVENTION DEVICB PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAPBTY DIVISION
225 FIFTH STREET
SPRINGFIELD OR 97477
OFFICE:
INSPECTION LINE:
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726-37 59
726-37 69
JOB LOCATTON:
ASSESSORS MAP I[:
OUNER:
ADDRESS:
CITY:
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BACI(FLOII PBRMIT IS 515.00 + $.ZS 1
TAX LOT II:
PHoNE ll L. 5fl
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$'.45 (ADMrN. r'EE) = 516.20
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ZIP:v722{
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ADDRES
CITY:Po./ /o STATD:
STATE TIIAT ALL INFORMATION ON TIIIS PERMIT/A
CONSTRUCTTON CONTRACTORS REGISTRATION II:
DY SIGNING TITIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE TIIE
BACKFLOV PREVENTION DEVICE IIAS BBEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-37 6
CORRECT.
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FOR OFI;TCE USE
TOTAL AMOUNT COLLECTBD:A AD
JoB *,QSD\OIDATE OF APPLICATION:
RECEIPT {I:
B
ISSUED BY:
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