HomeMy WebLinkAboutOccupancy Housing Code 1991-2-22
CITY OF SPRINGFIELD
Department of Pldnn~_g and Dev~pment
Building Safety Divis~ .
225 North 5th Street
Springfield, Oregon 97477:
726-3753 (Bus.) 726-3769 (Insp.)
HOUSING INSPECTI~
APPLICATION
DATE: r.4. ,tJ...~ 9/
JOB ADDRESS: ,i,~~'"[:~_:l
JJb:tt q [rJ rS?'
".:JSif1~L-P
. .
.. .:'1
~'.~'I
.. A --" --..,. l....'
. . '.,~ . ~ _' :, I ~ _: .
/J
OI-lNER: MA. N/!ON <TA c...k.s D N
OWNERS ADDRESS: ,2..71.3'1 ~~. f'~ /f)A, 471f!JJ-
APPLICANT: .l/t ~.-4..c-,.,/lrJ,A'~.A.A">'\ _ .
(j
APPLICANTS ADDRESS: ~~~
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: Ip((~-rS.3{p
('u.JJ.... b.e.-by"{>, 8 :30 [~s-r-
-H vY\ e... - 8 t cJ[) C\....,)
A $35.00 INSPECTION FEE IS REQUIRED AT THE TUm OF . 'J
APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE O~~ER OF THE PROPERTY TO BE
INSPECTED.
J%~~
- v
SIGNATURE OF PROPERTY OWNER
FOR OFFICE USE ONLY
DATE OF INSPECTION:
------------------------------------------------------------------------------
9.M.Q\
RECEIPT NillmER:, / q 3 2.. Z-
DATE PAID: 2. -2-2--'1/
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COl1MENTS: