HomeMy WebLinkAboutOccupancy Application 1995-10-13
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\ OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD BUILDING DIVISION
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DATE: ~/o/5ER. /3, /795 JOB NUMBER: 9'<.;;/c.rJ
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ADDRESS OF INSPECTION: Lf30 11/0/2. ''If-I. /f.:I1~ ";'SJ--;
OIiNER: -d1?'-K~2/6- l2\v6.i? /J!~&> PHONE NUMBER: ~4'//
OWNER'S ADDRESS: P- t!), /5~ 6/-ic?, h/3;lJ5A~ /ll.t-L. ~fl:: I
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APPLICANT: Ei? (c... 2.-ATlln 6,/2
APPLICANT'S ADDRESS: 5/1-n-1E fi.:5 .t'1/.50tJE.
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: 4-Xl--l ~ 5"7'.L.! S
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PROPOSED USE:
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A $35.00 INSPECTION FEE IS REQUIRED AT THE T~ME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE O\INER OF THE PROPERTY TO BE
INSPECTED.
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SiGNATURE O~~~~NER
FOR OFFICE USE ONLY
DATE PAID: /~ Y'i'J
DATE OF INSPECTION:
DATE OF CERTIFICATE OF COMPLIANCE:
RECEIPT NUMBER:
/722:3-.J
DATE OF REPORT:
COMMENTS:
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