HomeMy WebLinkAboutOccupancy Correspondence 1984-2-16
CITY OF SPRINGFIELO. '
Department of Public W s
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
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OCCUPAN~Y ~NSPE~ON
APPLICATION
DATE:
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JOB ADDRESS: Ate? ~I'.).sr
OWNER: ~/;".J ~li AP~
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O1VNERS ADDRESS: .J:;wt.
APPLICANT: ,..-;;-/ ..-::ftFIl/~!f1)
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APPLICANTS ADDRESS:, _ f',rh11i_ '
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: ~~?''~701
PROPOSED USE: ~/u.' 4.. -?int~~ ~p~u' d)2Pcc.-
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A $30.00 INSPECTION FEE IS REQUIRED, AT THE TIME
OF APPLICATION '
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THIS APPLICATION FORM MUST BE SIGNED BY THE O,mER OF THE PROPERTY TO
BE INSPECTED.
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SIGNATUP~ OF PROPERTY OIVNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:? - \\-1- <6q
RECEIPT NUMBER: -~ ~ '\....:1 -
DATE PAID: =< -;Z;-B Y e.t~,J (p~4lorz.
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
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