HomeMy WebLinkAboutPermit Plumbing 1998-7-31
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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
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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
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CITY: ..5P~ L.. i) j
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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"/.
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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,
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~SIGNATUREar Li.
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DATE
/
FOR OFFICE 'USE
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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 . ~..
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