HomeMy WebLinkAboutOccupancy Correspondence 1990-9-4
CITY OF SPRINGFIELD
Department ?f Planning an~ D~v:~ment
Buildlng Safety D1V1Sl'"
225 North 5th Street
Springfield, Oregon 97477 "
726-3753 (Bus.) 726-3769 (Insp.)
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,C:~nt' ~mbs>'" 4. 1990 V
OCCUPANCY INSPEC~
APPLICATION
SPRINGFIELD
DATE:
JOB ADDRESS:
OWNER:
"l4Q M"in Street
~nhn Bentzen. Trustee
i
OIVNERS ADDRESS: IRIS Clement Ave.. Alameda, CA 94501
APPLICANT::fnh MCCul\or h-=-Qm1''lJl Qp(L.o F~~
APPLICANTS ADDRESS: '7t./ r I ~r/!J ~I=-If Ilr-IJ~(\l' t:J7!:/:..Q.1
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: ~fLi~ j/~o~ ,
I?ea1 f~.-k, r&b mC0}//otfl (,,87-d(nl?' OV- .5:n.A'-fh.[Qce- rr7M<?dvur-Hb1
,
PROPOSED USE: tf:h r .. 9fh r.p . ?1' d:- 7 Lj I - 2AD "in
A $ 35.00 INSPECTION FEE IS REQUIRED, AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OvffiER OF THE PROPERTY TO
BE INSPECTED.
~
~!I~).J.j~ _i~h'- ~
SIGNATURE OF PROPERTY ~R ~,
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
RECEIPT NUMBER: I k?22--
DATE PAID: q .{p-7iJ
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: