HomeMy WebLinkAboutOccupancy Application 1984-11-20
CITY OF SPRINGFIELD. '
Department of Public Works
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~ON
APPLICATION
DATE: / /- :< 0 - <6Y
,
)Sf5/
hHA~-e i~7iA-/~-~
millERS ADDRESS: )1pc.;{~"n4b-.R /.41 #~A"ri
APPLICANT: \.1:;- t:; So -e ~ t':""" -h <:5 ?J (W.f? $ ;Ic:J cf.........- ];,p/;"--y)
,
APPLICANTS ADDRESS: C/D ~f/ /..o~/. A./ ~/ ~ 7'~.s-o?
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: ;7Y//7--~/?.-/
~i",r ()S--e IE aDen-. t6oJ1.........;;..r4 s I,.t.~ rll7f"P'-<~ ~~"
r , -' -
PROPOSED USE: /fi./de:>cn- F/1?/>>6 f0jL/-.J~...pA W/'t.5~-e ..,L k''t'',4.,'2 C:;d-j~,;
J / -
A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION .
JOB ADDRESS:
. c;D;
I( . /;
j{
-Ii- $LjoJ'3Lf
;'.1,
OWNER:
,-
:. ;~
THIS APPLICATION FORM MUST
BE INSPECTED.
BE SIGNED BY THE O.~E~ O~~E PROPERTY TO
Y:!4t.- i')~~ . .
. 1H F~<""-e. ,.cc.,~-.
//cJl6m2~cI ~ eA,'-I g;o~r- 5~~A-A?~ (I c? ~
, SIGNATUP~ OF PROPERTY OHNER
FOR OFFICE USE ONLY
DATE OF INSPECTION:
REci;;IPT NUMBER, lo~~ \. .
DATE PAID: \)j\). f) ('\ \q~
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: