HomeMy WebLinkAboutPermit Backflow Test 1996-4-5
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BACKFLOY PREVENTION DEVICE PERMIT APPLICATION !If
CITY OF SPRINGFIELD '
BUILDING SAFETY-DIVISION
'" FlPTII "REST OFFlCE' ",-",'
SPRINGFIELD OR 97477 INSPECTION LINE: 726-3769
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JOB LOCATION:
ASSESSORS MAP ~:
9bct
TAX LOT 11:~/~'"3
Ol/NER: Future " Hom.."
ADDRESS: ,,,q, Rillpr pninh' Or
CITY: Eugene
,PHONE ~: 4R5-1176
STATE: oregon UP: 97408
BACKFLOI/ PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) a $16.20
CONTRACTOR: Hunter IrriC'ation & Landscapinq
ADDRESS: .-J1,fw 4 <;4
,PIIONE ~: 935-3215
CITY: "~nli'''i', STATE: nr~'}~n
CONSTRUCTION CONTRACTORS REGISTRATION ~: 11 372
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,EXPIRES:~
BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE TilE
BACKFLOI/ PREVENTION DEVICE liAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSO STATE TIIAT ALL INFORMATION ON TllIS PERMIT/APPLICATION IS
CORRECT.
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FOR OFFICE USE
RECEIPT ~:
207 7}
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ISSUED IlY:
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DATE OF APPLICATION:
TOTAL AMOUNT COLLECTED:
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