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Permit Occupancy 1984-12-13
CITY OF SPRINGFIELD Department of Public Building Safety Divi~ 225 North 5th Street Springfield, Oregon 97477 ' 726-3753 (Bus.) 726-3769 (Insp.) ...O~'ON , APPLICATION SPRINGFIELD .::roiJ ~- 81/ 0 9/ ~ DATE';;:2 /13 / lfLI . . JOB ADDRES S: ~5 h --;s ,lL) (1PAJ1'iziJt1I//tL is u ' . OWNER: &flO-1, auAPA1;'a~ (;./~A; ,7& - 7q0 o~80 mINERS ADDRESS, "iC~ ~J.. (Q1l_~~ 'l~ O~97f/7'/ APPLICANT: -;ej) D, f3eA-1( APPLICANTS ADDRESS:F)-:2L/1-j (";:>eT/tJl/ EUJ')&Ne, Of( 91]4<07- """"" ~. - FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: ~SI~7-- :2;32)Lj Dft:: L?~ P~eSCot( fJ7 Rlll-/I1J'~ ' t4 T (l'efU;BltA1/lfft... ('.&o'R^,- PROPOSED USE: ,p NOTo L-I1fS A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME , OF APPLICATION' 9 7 ~,(J I flll7tVl!(jeO ~ 1)/ll/lCfleA.. f-(}, 975 011-/( Lu~/lJt:. 3Lj5'~ 30/;;' THIS APPLICATION FORM MUST BE SIGNED BY THE o~mER OF THE PROPERTY TO BE INSPECTED. . e~~ tJ a-e.L. SIGNATURE OF PROPERTY OlINER FOR OFFICE USE ONLY - - - - - - - - - ~ - - - - - - ,- - - -- - - - -, - - - - - - - - - - - - -.so h ~"O ~- - - - - - - - - - - - - - - - - - - - - DATE OF INSPECTION: RECEIPT NUMBER: '3 ~9' 0 DATE PAID: 1~/13/d <I fJ~ . DATE OF REPORT: DATE OF CERTIFICATE OF COHPLIANCE: 'COMMENTS: ~~.M;e::.~ 7:rr ~~:s ~->r#u8#/9r ~E&~ , .. ~ ~~~~,...., / &-~- 4~~4 '/':;-~-~~!.r3.+,~ ~-/>-e'T' ~>?, ./A./;:~Rr4/9-//cSA' ~l(~ - LerTe-~ ~ ;5>~ V/7'/T.7""rll'Y. /4/ Lt>R/Y~