HomeMy WebLinkAboutOccupancy Application 1996-6-3
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(541) 726-3/53
FAX (541) 726.3689
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
.
BUILDING DIVISION
=============================~==================~===============================
. .
DATE: -10 1.'2,} 9 b J
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ADDRESS OF INSPECTION: _llaeJ ~I_
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Jdvce.1
JOB NUMBER: jC,O 75"i'
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OlmER: ~ ~~r .
Ol/NER'S AD;RESS: <:?22!... ~ ~V-;;.
APPLICANT: T)O{)fll d t 4. )-€-o'f h iA Ad k ,. n 5
APPLICANT'S ADDRESS: 1./710 W. aD ,I' ~J:fl~"'-eJd. ()R
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER! 72;l7 ~ 7M 6
PHONE NUMBER:
q111t
.
================================================================================
PROPOSED USE: A hra~Jt pfftLe.-, J;)v,~/J<;.;ne~s ,r~f}:;u1i;Lt~.f1
(+'^" e.$j tf' re d. +, /(\ 1/f>.~rI~.Lfl.l rh/Je ~ ad (J IS ( no J . U
A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATIO)/ .
THIS APPLICATION FORM MUST BE SIGNED BY THE OlmER OF THE PROPERTY TO BE
INSP~ .-
GNATURE OF ~~
FOR OFFICE USE ONLY
DATE PAID:
0/5'/'7~
RECEIPT NUMBER:
2-17'fYe, /~
DATE OF INSPECTION:
DATE OF CERTiFICATE OF COMPLIANCE:
COMMENTS:
.DATE OF REPORT:
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PROPOSE~ FLOOR PLAN REQUIRED AT TIME OF APPLICATION
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