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HomeMy WebLinkAboutPermit Plumbing 1998-7-31 -r. ... .--, . - - f.. -.. r .~ ...... . ..~ re , follow rules a ose rules are se T T S Notification centeOOr'1"'6'thrOugh OAR 952-00b1y- A T PERMIT IS NOT . OAR 952-001- . of the rules . In090 You may obtain COP'~~e telephone . COMMENCED OR IS ABANDONED FOR o . . nter. (Note, . 'fi, ation ' calling the ~e OregoiAttitiFt~t'P'A~ENTION DEVICE PERMIT APPt'I.lTCAtcr:6r.f'Y PERIOD. numberfort e. 1_800-332-2344). CITY- OF SPRINGFIELD . . CenterlS .' BUILDING SAFETY DIVISION 225 FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 -~------------------------------------------------------------------------------ , JOB LOCATION: C::> -z. S- 0 A Sf cl"'1Z- I, Od- 34 31 TAX LOT #: 00 oa--n " ASSESSORS MAP #: OYNER: .- (C,6\A.. ~ I rz-l~S ADDRESS: l'/ 7 S- _s,' NO v '2 ---- CITY: ..5P~ L.. i) j I PHONE #: 7 <{- 7 <g 7 0 l( (~(L ZIP: c; 7 '(7( STATE: BACKFLOY PERMIT IS $15.00 + $.75 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16.20 CONTRACTOR: ~ I ~SokL LANDSCAp 0:"' J- :LR.iGlG..A,Ti D"/. . r ADDRESS:? () ~'o \< <+ 0 ~~ ~ PHONE #: C:::.KCf oC; z.<I CITY: ~L-1 GrJ;lJVt5: STATE: OIL . ZIP:q 7V oy CONSTRUCTION CONTRACTORS REGISTRATION #: S I 30 EXPIRES: {91 r BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOY PREVEN7ION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/ApPLICATION IS CORRECT, .Jf/lLe1~. (~ ~SIGNATUREar Li. ) 7~ ~ (--93' DATE / FOR OFFICE 'USE ------------------------------------------~--------------------------~-----(~ DATE OF APPLICATION: '1,-3/ -- q 5(' '" . JOB #: C5 0 8" ~ U RECEIPT #:' 030 c;q9 ISSUED BY:1\ ,fY\CLC!htioJ 0 '. TOTAL A~OUNT COLLECTEO:j \ le . ~.. -------------------------------------------------------------------------.-------