HomeMy WebLinkAboutPermit Miscellaneous 1988-4-14 (2)
CITY OF SPRINGFIELD
Department of Planning and Dev~pment
Building Safety Divis~
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~N
APPLICATION
DATE: ocrD~ 3.l"')~
JOB ADDRESS:
dJ: 3SV<610
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OWNER: At<)Ar.H~_; ro. I Ar,r=-.J"> +u<>-- nw'df=:~\
O\VNERS ADDRESS: '"'t'Lf
APPLICANT: MAf2.v A.....N
IA'. &t2:DAJ::>\'\J A( c:" J,- ~
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MA<--IL....."'ON
~
0), 401
APPLICANTS ADDRESS: 1L.i, J12.E:c 1./.1' ,
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l==:, )", .~;;. D<2-- 0],4-01:)
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FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: ~"'\z-3ZP)'5
PROPOSED USE: Nlc..lfl ~fL, /Q.~,AVt2-ArJl
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A $ 35.00 INSPECTION FEE IS REQUIRED AT T}lli TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OvillER OF THE PROPERTY TO
BE INSPECTED.
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~IGNATURE OF PROPERTY 01VNER ~ ~
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
RECEIPT NUMBER:
I 1- t(qy
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DATE OF REPORT:
DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
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