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HomeMy WebLinkAboutPermit Mechanical 1990-7-24 (2) ~.. . SPRINGFIELD l)6p . WOOO STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225'Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 Job Location: d R.:J"Y c: <:2/77 e Fa,eh/ !2q/ Assessors Map II: 17 0'< c:?OJ..<.fd /'/00 Tax Lot II: //0 <:) Owner: I-kJe.n L,,,,dc:re.h -J"./'c L..'Jdyl'<:..... uJl k. .Mdress: I /<f;;J.. ~ S. w, Rre.l1 i'1tIA-r. k Phone II: &, 3 (; , 900 ~ City: {J CJ~.I-) 4", J I State: (9 (' E' Zip: 9 7 a./ '7 Va 1 ue of Wood Stove/Insert: '~ .!3:ff).oO (please circle approprlate appllanceJ Preliminary Inspection is $15.00 (prior to installation of insert) Wood Stove/Insert Permit is $15.00 + $0.75 state surcharge Type of Inspection Requested: wood..s-bue.- Per"""., , Contractor: L\ 'A K ('\ OLU ....... Address: Phone II: City: State: Zip: Co~struction Contractors Registration II: Expires: By signing this permit/application, I agree to call for an inspection(s) as required (726-3769). I also state that all information on this application/ permit is correct and that I was provided with the Wood Stove Safety information ~WOOd burning appliances and preliminary inspection standards. tM.a...R-<I d1'h.t9~......... a.~ J,ry I9-U t-r1.Vr ' 7 - .;L '-{ -70 19nature V (j 0_ uate FOR OFF ICE USE REQUIRED INSPECTION(S): _ STOv"EpINSERT 'I-Q4.Q/) \S.f'\~ Date of Application: Total Amount Collected: Receipt #: I~ Issued By: PRELIM I NARY q()()q~( (1 ~rf\o..j Job II: Checked for Delinquencies: L-----'" Checked for Historical Status: ~