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vOCCUPANCY INSPECTION APPLICATION
EXISTING BUILDINGS
CITY OF SPRINGFIELD BUILDING DEPARTMENT
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OF APPLICATION
ON FORI,I }ruST BE SIGNED BY OWNER OF THE PROPERTY TO BE
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vOCCUPANCY INSPECTION APPLICATION
EXISTING BUILDINGS
CITY OF SPRINGFIELD BUILDING DEPART]\,IENT
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JOB ADDRESS:(JC Ni]MBER OF I]NITS:
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FOR ACCESS TO PROPERTY - PLEASE INCLUDE TELEPHONE NI]MBER:
THIS APPLICATI
INSPECTED.
A $24.00 INSPECTTON FEE IS REQUIRED AT THE TIME
OF APPLICATION
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vOCCUPANCY INSPECTION APPLICATION
EXISTING BUILDINGS
CITY OF SPRINGFIELD BUILDING DEPARTMENT
DAIE, lZ-tS-BZ
JOB ADDRESS:NU},IBER OF I]NITS:
owNER: CSoh C nc [. - or*J
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OWNERS ADDRESS:
APPLICANT,-G
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A $24.00 TNSPECTTON rEE rS REQUTRED AT TriE TrI,rE
OF APPLICATION
THIS APPLICATION FORI"I I'IUST BE SIGNED BY OMVER OF THE PROPERTY TO BE
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FOR OFFICE USE ONLY
DATE OF INSPECTION: DATE OF CERT. OF COMPLIANCE:
DATE OF REPORT:RECEIPT NIIMBER:
REMARKS:
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FOR ACCESS TO PROPERTY - PLEASE INCLUDE TELEPHONE NIIMBER:
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PBO PE BTY MA \VAG EM EIIIT, I\VC
RESIDENTIAL AND COMMERCIAL
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749 MAtN STREET
SPRTNGFTELD, OREGON 97477
BUS: 746-8230 ANDREE BURDICK
HOME: 726-1674 PRoPERTY MANAGER
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