HomeMy WebLinkAboutOccupancy Housing Code 1981-9-12
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HOUSING INSPECTION APPLICATION
EXISTING BUILDINGS
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CITY OF SPRINGFIELD
BUILDING DEPARTMENT
DATE: <j/;y/i;!
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JOB ADDRESS: $&'T Hili).) Sf
OWNER: /1(. hwt:1U - r.:. I ')/,' ~
OWNERS ADDRESS: IJJlltllA1r, ~T
APPLICANT: ~-
APPLICANTS ADDRESS: ~
FOR ACCESS TO PROPERTY - PLEASE INCLUDE TELEPHONE NUMBER: {,,J'l-71'13 ' ~
NUMBER OF UNITS:' , /,
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.A $24.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION
THIS APPLrCATION FORM MUST BE SIGNED BY THE OWNER 07PJ' P OPERTY TO
INSPECTED.
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, -.S1GNATURE OF PKuPENY OWNF.~ -
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DATE OF INSPECTION:
DATE OF CERT. OF COMPLIANCE:
DATE OF REPORT:
REMARKS:
RECEIPT NUMBER:
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