HomeMy WebLinkAboutOccupancy Application 1997-3-24
OCCUPANCY INSPECTION APPLICATION
225 FIFT/-I STFlEET
SPRINGFIELD, on 97477
, (541) 726-3753
FAX (541) 726-3689
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE: t-\&~\.... :l4) \OQ, JOB NUMBER: q~,Yf0
ADDRESS OF INSPECTION: 56&" W~-\- (~iV-teAJI\.h'a.J B\VJ..
o lJNER : -C. oe2lV-t -.2. IV I\) \;C~.l C e."I'\'-ev'- a.~c:r...
OWNER'S ADDRESS:
PHONE NUMBER: ,-~4.\ - ~~ -4l\.~
APPLICANT: 'T. \J.L i w~
l') P, P. ~CUJ ot2.r-~ / 11 eU.lL>lL () l \ \aa Q
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APPLICANT'S ADDRESS: 1\ 1..\Ol"\ s..e (,.., -\:11-- ~e \\ -eUUQ I U la... G( <rlCXJt.-{
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER:
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PROPOSED USE: R e... --\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 OlJNER OF THE PROPERTY TO BE
INSPECTED.
}:\~ cJ.~J?~ ?kAIo,j)i AM~
SIGNATUR~ OF\PROPERTY OWNER -~-- \ ~
--------------------------------------------------------------------------------
FOR OFFICE USE ONLY
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DATE PAID: 9....2.&"-57
RECEIPT NUMBER: :2. S'o ~2
,DATE OF REPORT:
DATE OF INSPECTION:
DATE OF CERTiFICATE OF COMPLIANCE:
COMMENTS:
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PROPOSED FLOOR, PLAN REQUIRED AT TIME' OF APPLICATION
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