HomeMy WebLinkAboutOccupancy Application 1997-4-21
225 FIFTH STREET
SfJRlNGrIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE: /./:..-Zl-77 JOB NUMBER: 0:!()fo07
ADDRESS OF INSPECTION: <0'-13 Wt~7 f!..eJJ Ic}JVJAL BL VD
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OWNER: C-i=--rLJ 110::::. ~AJI ~_ c..t;;;N, c=.JL A-S$DC.I Arb\'
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OlJNER' S ADDRESS: K'.b 9 N w /LJA LL 6r oS LJ' 77Z o1l>3
PHONE NUMBER: (~)3;;2.- '(II z-
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APPLICANT: l1e,j-l ~A X7DJJ (7J)L. S-b~1)
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APPLICANT'S ADDRESS: 11'11- ALoeIDCrt: (JL ~.E:6jA){;'FJEL{J IJf<. q.:J..!:ilf
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: LoLA. d Q5'-/-7b'-lJ,
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PROPOSED USE: Ex UGJS C. /(DDf1r)
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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
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FOR OFFICE USE ONLY .
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DATE PAID: L)-62Lf -97
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RECEIPT NUMBER: ();) <)Ui/1 C)
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DATE OF INSPECTION:
DATE OF CERTIFICATE OF COMPLIANCE:
,DATE OF REPORT:
COMMENTS:
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PROPOSED FLOOR PLAN REQUIRED AT TIME' OF APPLICATION
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