HomeMy WebLinkAboutOccupancy Correspondence 1996-10-17
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SPRINGFIELD
OCVnOf'MCNr SCflVICCS DepI1f7TMCNr
225 FlI'nI STReeT
Sf'FIINGF/U.O. on Yi'477
(!,41) 726-3753
FAX (541) 726-3689
OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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OIlNER:
l-J~1'"'TT'I()ny ~...:._..:;Q~ 1"'/0 Borh Ill'.....;',.."
PHONE NUMBER: 342 1707
ADDRESS OF INSPECTION: 100 ~in SrrAPr_ Snringfipln
\70?n'5~1CJY&:;O
OYNER'S ADDRESS: P.O. Box 100~3-Eugpnp nR 97440
APPLICANT:
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C'h'~L-h~" - qg<!- 'ft;;)'f1
lJJo(K - "~b - 4/8:L 1f00000e
APPLICANT'S ADDRESS:
137 N. Polk st. Euaene. OR 97402
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: ~~=rk r.i~hpl ~81-9001
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PROPOSED USE:
Food and Beveraae Service
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OIlNER OF THE PROPERTY TO BE
INSPE D. Y /
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FOR OFFICE USE ONLY
DATE PAID: j.D-?1 - 1.Cf
DATE OF INSPECTION:
DATE OF CERTtFICATE OF COMPLIANCE:
RECEIPT NUMBER: CJd35Lf ~ .. ....
.DATE OF REPORT:
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COMMENTS:
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PROPOSED FLOOR PLAN REQUIRED AT TIME OF APPLICATION
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