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HomeMy WebLinkAboutPermit Miscellaneous 1979-06-18g-t t ;f -4Lt s1 TIOUSING INSPEC'I'ION APPLICATION r EXISTING BUILDINGS CITY OF SPRINGFIELD BUILDING DEPARTI\IENT DArE:__ f - 16-77 JOB ADDRESS NUMBER OF UNITS: owNER: S,rJ Ac -ADDRESS:r'& APPLICANT:tm ADDRESS: -9.2e ar &4o FOR ACCESS T0 PROPERTY - TELEPH0NE NUMBER AS Z Ofl/a a A $20.00 TNSPECTION FEE rS RI-:QUTRED AT THE TrN{E OF Appr,rCATrON. THIS APPLICATION FORI\{ },IUST BE SIGNED BY THE OhNER OF THE PROPERTY TO BE INSPECTED. SI FOR OFFICE USE ONLY B 5 RO Date of Inspection:Date of Cert. of Compliance: Date of Report:_ Receipt Number:_ REMARKS J CITY OF SPRINGFIELD CirY Holl Springfield, Oregon Deportment of Public Works OFFICIAL RECEIPT No. B 50687 9 nt SICNATURE SHELTON.TURN EUL! BY 1-