HomeMy WebLinkAboutPermit Housing Code 1983-10-19 (2)
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CITY OF SPRINGFIEL[
Department of PublIc Wurks
BUIldIng Safety DIvIsIon
225 North 5th Street
Sprlngfleld, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
HOUSI~G INSPECTION
APPLICATION
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JOB ADDRESS ~"_"W'1 \, '1 . J !!!!II' ~_
OWNER ~CL",,",--e.S ~v,-~<;1- 6...a.1-/"t"'----cP /;
OWNERS ADDRESS 20 3 L( Cec......+ e..\..--. v- " CL \ t3 (vcP~
APPLICANT,
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APPLICANTS ADDRESS
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER ~4/~ 2 359 (~...,.e)
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A $30 00 INSPECTION FEE IS REQUIRED AT THE TIME OF
APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE
INSPECTED,
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S~NATURE OF PROPERTY OWNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION
RECEIPT NUMBER l.o \'t>tp"1
DATE PAID /0 - Jq- R,~
DATE OF REPORT
DATE OF CERTIFICATE OF COMPLIANCE
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