HomeMy WebLinkAboutOccupancy Correspondence 1985-5-22
CITY OF SPRINGFIELD
Department of Public wo~
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
eJCCupC:{J7 c-::ta
=fleV~~u INSPEClIO~
APPLICATION
SPRINGFIELD
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DATE: 5 \,:)~\ 9."\. ~ .
JOB ADDRESS: ,_ 1 ~ \ '\'\(Wy\. S+I\'fe-t S~H;' "'1 (~\J( nf\P~nlf\)
OWNER: ~~ ~ '
OWNERS ADDRESS:j37'7-1J2W~&~_ ~./J,2..~97c/77
APPLICANT: \ [-,,\ \'Y\" \\"\clcw ~O',- ~n ~ ,- Y1AJ...U ,\ (^ t\r"-
APPLICANTS ADDRESS: l~ lYil (J I ~ S-\-J\(O -e\ .'\ r 1\ 1;'" ~ C.. ({ nllf'~...\,,^-
FOR ACCESS TO PROPERTY - - PLEASE INCLUDE TELEPHONE NUMBER: lll\, \1.Nl~ <
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A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME OF
APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE
INSPECTED.
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SIGNATURE OF
FOR OFFICE USE ONLY
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PRO~TY OWNER -
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
RECEIPT NUMBER: \o41q) ~.,
.DATE PAID:, .&=)-.(XA -~SA\'~
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COMMENTS:
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Ron R. Peery
Executive Vice President
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Centennlal:S:Bank
Administrative Offices
1377 Mohawk Blvd. . Spriogfield. OR 97477 . ()03) 741.17H
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" . SENDER: Complete nems 1, 2, 3, and 4.
~ . Add your address In the .. RETURN TO"
. - space on reverse.
~ : (CDNSUL T PDSTMASTER FDR FEES)
~ t, The _ng S8I'Itc8Is requastad (cIledc one), ..
~ - ~howtowhomanddat8dellv1r8d ............... ~
! D SIlow 10 whOm, claIO, lIllladdresso1_ry..
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TOTAL .1.'7
.<;:,...... ~ 3, ARTICLE ADDRESSED TO:
:" - Centennial Bank/Attn. R. Perry
\ 1377 Mohawk Blvd.
~r1Q~fiplrl. OR Q74L7
71YPE OF ~ERVICE: ARTICLE NUMBER
J - DREGISTEREO DINSUREO P329968106
. DCERTlFIED DCOD
DooRESS MAIL
T (AIwIy1 obtain algnature olld <ra.... or agent)
, 1 haW OOlIvod tho artIclo doscrlbod o!love,
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75, DATE OF OEUvalV POSTMARK:
(In;I1D1ClDrMrlllIdI) _
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a, ADDRESSEE'S ADDRESS (OnIy'_"
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UNITED STATES p. SERVICE'
OFFICIAL .BUSlNESS
SENDER INSTRUCTIONS
_ ,.., ...... I1Idra1. .1IlI ZIP Cad... till ._ l1li...
. COmptItI1lImI1. 2, I, lad 4 on till rntrIl.
o A_ID_oI_WopacopermIII.
oIIII_llIIIlD_oIartlc11.
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RETURN
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PENALTY FOR PRIVATE'
USE, S300
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CITY OF SPRINGIFELD - BUILDING DIVISION
(Name 01 sender)
225 NORTH 5th STREET
(Street or P.O. BoX) ,
SPRINGFIELD, p~ ~17l1U
(City, State, and ZIP COde)'
P 329 968 106
RECEIPT FOR CERTIFIED MAIL
~
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~ ~ I SPECIAL DELIVERY
I RESTRICTED DELIVERY
~ j ! i ~.ll=-
\ ~ ~ en SHOWTOW1iOM. DATE,
Ct) ~ Ii: :~:::ESS OF
J ~ CI ~ SHOW'TOWliQMANDOATE
~ OEllVEREDWITHRESTRICTEC
: ; i ;;i~g,~i:i$~fH
~ RESTRlCIEDOELlVERV
TOTALPOSTAGEANDFEE~
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" 0( POST....-!"'~OR~!E \';"
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NO INSURANCE COVERAGE PROVIDEO-
NOT FOR INTERNATIONAL MAil
(See Reverse)
I SENTlQ
Cent.Bank/Attn.R. Perry
I STREET AND NO.
1377 Mohawk Blvd.
I PO'~pA;~~Ngfiefa, OR 974~
I POSTAGE S . .-
CERTIFIED FEE , i 0 c
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!...75'
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STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE, AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES, (see kenl)
1. If you want this receipt postmarked, stick the gummed stub on the left portion of the address side of
the article, leaving the receipt attached, and present the article at a post office service window or
hand it to your rural carrier. (no extra charge)
2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address
side of the article, date, detach and retain the receipt, and mail the article.
3. If you want a return receipt, write the certified-mail number and your name and address on a return
receipt card. Form 3811, and attach it to the front of the article by means 01 the gummed ends if space
permits. Otherwise, affix to back of article. Endorse front of article RfTURN RECEIPT REQUESTED
adjacent to the number.
4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee.
endorse RESTRICTED DELIVERY on the front ot the article,
5. Enter fees for the services requested in,lhe appropriate spaces on the front of this receipt. If return.
receipt is requested. check the _ble blocks in lIem 1 of Form 3811.
6. Save this receipt and present it ake inquiry. p 33
. 7 "'G 0: 1980 1-003