HomeMy WebLinkAboutPermit Backflow Test 1996-4-5
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BACKFLOY PREVENTION DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY-DIVISION
225 FIFTH STREET
SPRINGFIELD DR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
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JOB LOCATION:
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TAX LOT U: c::z>/~,"3
ASSESSORS MAP U: /?-0 ;r _~-?O
OYNER: Future B Homes
PHONE U: 4 R <; -11lfi
STATE: oregon ZIP: 97408
ADDRESS: l<;<!l Hi 1rpr Pni n/-<> nr
CITY: Eugene
BACKFLOY PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20
CONTRACTOR: Hunter Irriqation & Landscapinq
ADDRESS: Rox 'l5 4
.PHONE U: 935-3215
CITY:~~..~. STATE: OrDgnn
CONSTRUCTION CONTRACTORS REGISTRATION U: 11372
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.EXPIRES:~
BY SIGNING TIlIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE TilE
BACKFLOY PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS
CORRECT.
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FOR OFFICE USE
DATE OF APPLICATION:. i/0'.(,
RECEIPT Q: 2L) '7~9 ISSUED DY:
TOTAL AMOUNT COLLECTED: ~~.~
~DU: ~~"3"3'c,- ,
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