HomeMy WebLinkAboutOccupancy Correspondence 1991-10-8
--
.
:.
OCCUPANCY INSPECrION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
===================================================-----~===========~====m====
DATE: /t> -? - 9'1 ' JOB NUMBER: 1{! t;x1
ADDRESS OF INSPECTION:
h ~ 0 M // I;r/ s 7,
OIlNER: /141 k c /t 1..4 C I< /5u~ d
OIlNER'S ADDRESS: t,J 7 ~~, /__IL! /~.'
,f , /
15 OOA/E ~/NTW(r
APPLICANT'S ADDRESS: n'l ,#.,) ~
I
PHONE NUMBER:
&~e-,....Q
,j-
6?7-d'o/ o!.
APPLICANT:
/
;JL~:~
5ol~:;;;; 3
/1...--
f 7'y?7
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER:
=======================================------------~~~~------===================
PROPOSED USE:
jJ ~(N T s/l-tJ7
<.,->
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
~~ED. 7 UV fl/J
'Y/0P(J~ --::>
SIGNATURE OF PROPERTY OYNER
*
FOR OFFICE USE ONLY
-------------------------
DATE PAID:
ID-&' -1/
RECEIPT NUMBER:
216zE
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: