Loading...
HomeMy WebLinkAboutPermit Plumbing 1994-7-27 BACKFLOW PREVENTION DEVICE. PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING. SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: 726-3759 INSPECTION LINE: 726-3769 ( , Job Location: ~('2- ~ / '5 T Assessors Map #: \ f)()3~_()~~ Tax Lot #: Owner: AAx7V Lf.! V ;J /1-/ (,.! 1/.lJ /iI F1<~ / ( \ / Address: 2 7 J 7 j), .? 2 /lJ} ')/-; Phone if: City: . J ~ /5) State: AI( nrs(\ I' 74'7-/d~ J Zip: /'7 <I?a Backflow Permit is $15.00 + $0.75 State Surcharge Contractor: ItGAJjI3< !--qAQjC;//? /~ Address: Pi tJ v ?? N 4 }- L ~ T' I City: ~;(~)L7~ State: Phone if: ~ Zip: 17~Z5 7 ~/Jo/YJ - ~ ,j Construction Contractors Registration #: / / "< 7 ?_ Expires: By signing this permit/application, I agree to call for an inspection once the backflow prevention ~evice has been inst~lled and is visible for inspection (726-3769). I also state that all information on this application/permit is correct. ' /f:tl:L /~ /-~ ~',- 5Jr')/ Uate FOR OFFICE USE Date of APPlication:3h,?/ r1 J~g:. 91://1.7 Receipt g: /~~ Issued By: .~~ Total Amount Collected: ~ /(,,~.