HomeMy WebLinkAboutOccupancy Housing Code 1987-10-28
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Building Safety Division
225 North 5th StreetA
Springfield, Oregon 974'"
726-3753 (Bus.) 726-3769 (Insp.)
HOUSING INSPECTION
APPLICATION .
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OWNER: ....-)~ 1/(.) f/3-c:.h.n ~
OWNERS ADDRESS: ~ ~",{c::~ _
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FOR ACCESS TO PROPERTY - - PLEASE INCLUDE TELEPHONE NUMBER: <<b' f/ - 38' dO
DATE:
JOB ADDRESS:
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APPLICANT:
APPLICANTS ADDRESS:
A $35.00 INSPECTION FEE IS REQUIRED AT THE TIHE OF
APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE
INSPECTED.
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SIGNATURE OF PROPERTY OWNER
FOR OFFICE USE ONLY
DATE OF INSPECTION:
DATE OF REPORT:
RECEIPT NUMBER:
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. DATE OF CERTIFICATE OF COMPLIANCE:
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DATE
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PAID: /0 - ;:'28 -87
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