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.
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FOR OFFICE USE ONLY
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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
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SICNATURE
SHELTON.TURN EUL!
BY
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