HomeMy WebLinkAboutOccupancy Correspondence 1991-1-10
CITY OF SPRINGFIELD~
Department of Planning and Dev.nt
Building Safety Divisi .
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPEC~'l
APPLICATION
SPRINGFIELD
DATE: ~ /1JIAA.IJIM.\ I~I
JOB AD~SS: ~ 18S' Goo..if'.W~ '
OWNER: ~;Il MCCh~ - \J(:,~. r,Jdtu :rAte..
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OWNERS ADDRESS: I,C;/() J...I.~ q'Lfi..ub. r;~,,; D~<r: 9'11./0.....
APPLICANT: CAlC f' e let:) S 1 (.aL. _ L ~ " - ~ .') "s )
APPLICANTS ADDRESS: I)~ ":;"k' 2. 1\ ,::JL cJ -10".., ,t 1: 6A.. 9?l/tJ 'f
· ' . ~.ct..-G1\l<.C~- ,g&og.,,,,
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: Usce-fb..- 7C(1-"'<t
,P.1. ~n.sc. ~A~~ (;.AA-?,
PROPOSED USE: LJ ; Z.!! A A,vrl.
C:..ILD Soq: 1'-0 ~____:,L ~~
SvA Shoji:>
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A $ 35.00 INSPECTION FEE IS REQUIRED AT THE TIME
. OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE .OvnffiR OF THE PROPERTY TO
BE INSPECTED.
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SIGNATURE OF PROPERTY OWNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
DATE OF REPORT:
\ . \'l ,q \
RECEIPT NUMBER: I Y!J (p~
DATE PAID: / -/ Lj -c;/
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: