HomeMy WebLinkAboutOccupancy Application 1996-10-1
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SPRINGFIELD
OCCUPANCY INSPECTION APPLICATION
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',I'IIINGfll_ID 011 [I/oIf I
(541) /263753
FAX (541) 726 3689
CITY OF SPRINGFIELD
BUILDING DIVISION
ADDRESS OF INSPECTION:
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'3381 [J,c-(o!(c-r Dr' - 17t71f -
/g~<::>-;;; <t><f.':i-I,,- cr:::?3~
OIlNER. 5AJVit
OWNER'S ADDRESS: {A;r/~
APPLICANT. g ({ BM Ii
APPLICANT'S ADDRESS: 338'/ ChfnJf-
PHONE NUMBER:
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER.
II - ?7lf76
3{S - /83 t or 7'-N - 95"5()
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PROPOSED USE: L0/V1MI~1r(./ kJ"rchc!l
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE
INS?1> ~-
SIGNATURE Of PROPERTY OWNER
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FOR OFFICE USE ONLY
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DATE PAID.
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RECEIPT NUMBER. -;;:;77~'3 ~
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DATE OF REPORT:
DATE OF INSPECTION.
DATE OF CERTIFICATE OF COMPLIANCE,
COMMENTS:
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,
PROPOSED FLOOR PLAN REQUIRED AT TIME OF APPLICATION