HomeMy WebLinkAboutOccupancy Application 1981-6-15
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OCCUPANCY INSPECTION APPLICATION
EXISTING BUILDINGS
CITY OF SPRINGFIELD
BUILDING DEPARTMENT
DATE:
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JOB ADDRESS: 126/ CE'f0TE>(\./rV1iK- 13LvDNUMBER OF UNITS: 'I
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OWNER: C)TtrLlrJ 1.1) ~ <;~"TT ADDRESS: 7~'S fZ..tVE:tUJ/~ ~1s7~ Q740<
APPLICANT: WIU.lr4M D' S6rDEIL A~~ ('iA~~SS: 14Jo OA/e. S;f: t::;:VbE:.:^Je- q 74-lJL-
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FOR ACCESS TO PROPERTY - TELEPHONE: L-C)./+fZ."f;Jln t-11Lle:<L-' 7c.rb- 7G 30
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A $20.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROEPTY TO BE INSPECTED
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f(..t\,,--~l-+Av~ ~L.:: . SuSr-i/Tl eD SIGNATURE OF PROPE Y O\mER
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FOR OFFICE USE ONLY
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Date of Inspection :'-~ \ \f\().... \\0 \9,\
Date of Report:
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~ Date of Cert. of Compliance:
Receipt Number: 51o'l \'r
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REMARKS:
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