HomeMy WebLinkAboutSpecial Inspection Occupancy 1994-2-14
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE: ~1-1i.f- tfif
ADDRESS OF INSPECTION: J5:lS CA.,~~ Lc,./.~
JOB NUMBER: 9'4{)172
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OWNER: m.A,5vJ'>"'--L./ ....... a~'.k,::.r CtY~ (;:?A(_U7'\r....~__ PHONE NUMBER: 'l~Y-;"',C;-O(Sk"'')
OWNER'S ADDRESS: .3 (c., ~ _ ~G"-~ ~V_\ ~-~'" ~-<---~ q 7 Y 0/
APPLICANT: ~~" ,,-~-r- p, RA u..,'--"',-",,- (. /5r G,.L~.,.Q ...S;-t.......:l,~)
APPLICANT"S ADDRESS: 777 AJ 7_ ;;) tl.Q. C~ a 0.. ~ 1 ,/IU. c~7J-.~P
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: 4-'i(y -S-t:)o~
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PROPOSED USE: C. 0Yv.JQ...>, T
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE
INSPECTED.
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SIGNATURE OF PROPERTY OWNER
FOR OFFICE USE ONLY
DATE PAID:
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RECEIPT NUMBER:
DATE OF INSPECTION:
DATE OF REPORT:
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DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: