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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 ================================================================================ DATE: /./:..-Zl-77 JOB NUMBER: 0:!()fo07 ADDRESS OF INSPECTION: <0'-13 Wt~7 f!..eJJ Ic}JVJAL BL VD 7?OI3IE!12r )./. lSevNt:::J I )/<.I,4A>>l6/~ o~ OWNER: C-i=--rLJ 110::::. ~AJI ~_ c..t;;;N, c=.JL A-S$DC.I Arb\' % PIZ..~PE72.JY ~5~.s ~ OlJNER' S ADDRESS: K'.b 9 N w /LJA LL 6r oS LJ' 77Z o1l>3 PHONE NUMBER: (~)3;;2.- '(II z- J:JEJU~ oR!. 977()j APPLICANT: l1e,j-l ~A X7DJJ (7J)L. S-b~1) / 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, ================================================================================ PROPOSED USE: Ex UGJS C. /(DDf1r) ,. 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 Ir~( . I:~:~:~_::::::::_:::::_---------------------------------------------------- FOR OFFICE USE ONLY . -------------------------------------------------------------------------------- DATE PAID: L)-62Lf -97 , .. . RECEIPT NUMBER: ();) <)Ui/1 C) .. DATE OF INSPECTION: DATE OF CERTIFICATE OF COMPLIANCE: ,DATE OF REPORT: COMMENTS: , ! PROPOSED FLOOR PLAN REQUIRED AT TIME' OF APPLICATION . .... ...... z:... f to D 3 I> ~r , ,'0 --"' _.J ~\ ?R ~ ~} .'? <:7 10 ~- ., 5 3 t:-I 'r:5 , (1") "\) ~) fJ 0 C /'<;J (1\ 0 0 c -' I _I ~ --..) c !;;- 0- --J