HomeMy WebLinkAboutOccupancy Application 1996-7-10
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225 FIFTN STREET
SPFIINGnEL0, OR 97477
(541) 726-3753
FAX (541) 726-3689
CITY OF SPRINGFIELD
OCCUPANCY INSPECTION APPLICATION
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BUILDING DIVISION
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Ol,lNER: <PYosfohL, S~ ~c.. PHONE NUMBER: 3SJ--if// z,.
OVN~R'S ADDRESS: ~\lW \AbOQ Sf S,id.R W~ &4R. CfnOI
APPLICANT: ~~9 (JOWl ' .,
APPLICANT' S, ADDRESS: d.-3Ci) i~}OAh~ t:Fl7
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FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: 3<f3-JYq7~ \.iU.X,A.
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE Ol,lNER OF THE PROPERTY TO BE
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SIGNA~ OF PROPERTY OWNER' '1() ~
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FOR OFFICE USE ONLY
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DATE PAID: f).l\.C\\p ~EIPT NUMBER: AM~.- ".'
DATE OF INSPECTION: ,DATE OF REPORT:
DATE OF CERTiFICATE OF COMPLIANCE:
COMMENTS:
, PROPOSED FLOOR PLAN REQUIRED AT TIME' OF APPl'icATION
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