HomeMy WebLinkAboutPermit Backflow Test 1996-4-5
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BACKFLOV PREVENTIO~ DEVICE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFBTY-DIVISION
225 FIFTII STREET
SPRINGFIELD OR 97477
OFFICE: 726-3759
INSPECTION LINE: 726-3769
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JOB LOCATION: . q 1.. t'J ~ ~ ~ ~ W 6Vt\-
ASSESSORS MAP #: /'~'3"~2"'5'~ TA~T II: O"/~ 5
OVNER: Future B Homes
ADDRESS:--15,9"1 Hi vpr pni I'll'<> nr
CITY: Eugene
PHONE #: 4R<;_"I176
STATE:
oregon
ZIP: 97408
BACKFLOV PERMIT IS $15.00 + $.75 (STATE SURCIIARGE) + $.45 (ADMIN. FEE) = $16.20
CONTRACTOR: Hunter Irrigation & Landscaping
ADDRESS:~ny 4<;4
,PHONE #: 935-3215
CITY:_",--,_"~ STATE: nr~'J",n
CONSTRUCTION CONTRACTORS REGISTRATION Il: 11372
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1>XPIRES: tf/3D&L
BY SIGNING TIIIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE TilE
BACKFLOV PREVENTION DEVICE liAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION
(726-3769), I ALSO STATE TIlAT ALL INFORMATION ON TIIIS PERMIT/APPLICATION IS
CORRECT.
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FOR OFFICE USE
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TOTAL AMOUNT COLLECTED: /~.2~
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