HomeMy WebLinkAboutOccupancy Housing Code 1980-3-4
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HOUSING INSPECTION APPLICATION
EXISTING BUILDINGS
CITY OF SPRINGFIELD
BUILDING DEPARnlENT
JOB ADDRESS: /5 3R" ~ 13/(/ d ,
OWNER: 7l~r:5hn (~
APPLICANT: -;5d/?'U k..s ct..bOt/"t"
NU~lBER OF UNITS: I
ADDRESS: IS- 3~ /~ tL....- 15/0 c:I ,
ADDRESS: ~> 4-.s; ~b/~
DATE: 3 - <1 - .~ 0
FOR ACCESS TO PROPERTY - TELEPHONE NU~IBER 7 </ / - / =; 7. ?
A $20.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION.
THIS APPLICATION FOR~l MUST BE SIGNED BY THE OWNER OF TIlE PROPERTY TO BE INSPECTED.
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. /f-- SIGNATURE OF~PRdPERT'y-OWNER
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FOR OFFICE USE ONLY
Date of IDspectioD:
Date of Cert. of Compliance:
Date of Report:
Receipt Number:
REMARKS:
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