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Home My WebLink AboutPermit Backflow Test 1998-1-27 -.. , e--- ~f \~ BACKFLO~ PREVENTION DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION .' ,'{J. 6:~, "'" I''''. , 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 .. ;::::::::;::;-:---~~~~Cil-~~~;-~:::;;':;----- O~NER: .;r~rs Ht1,/t'?,!;;> L, L, C. / ADDRESS: --7:'0. &.?c' S:;::..;'....-z<e~_":. PHONE U(5rj~6ff2>5~U '. p.p/pv.-' STA~:- ZIP: J'; O~ BACKFLO~ PERMIT IS $15.00 + $. 75 (STAT~S~)j:~4 + $..45 (ADMIN. FEE) = $16.20 OJ'; ~'."'P.' J/ C'~~ 'YO-sJ ~J- CONT~CTOR; 1'1 .e-VS /-!/) ~~""'&" ~<,<'n. O'~, r:()& - . '6l .(.(:; v~ ~< ( ) ADDRESS: v:;2/?c;-U"> !70ed, ~O^ e><,<'.o ~''''E jl: ~03 b1-./' m~J ',0 '{S> . ,~~<,<' - CITY: //0,7 /41'1// STAT~17.o~~,o~,('~l ZIP: P?7..2?-;- CONSTRUCTION CONTRACTORS REGISTRATION U: 1~ / O"~4',(-~~r/n ~}RES: 9' 1'6 v/;; "JIb.. ,.,... /7 0-9 'vJ- BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLO~ PREVENTION DEVICE liAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769) . STATE THAT ALL INFORMATION. ON THIS PERMIT! APP.L LI!~CCr Tl)ON jf.j5 n r ~ CORRECT. 7 0) . ~ <t1. ,?x t ./..--- .- . ~~/~ .v? (/ .-. .";' . CITY: '-. "Fha FOR OFFICE USE ::~:-::-:~~~:::~:::~-----i~~f\~~~--------~----~-------:::-:~lJ\~()I(:)'l- RECEIPT II: ~~5<6C-\.. ISSUED BY: (\\f\ll.; TOTAL AMOUNT COLLECTED: c~\.{jf) ~. ~. --------------------------------------------------------------------------------