HomeMy WebLinkAboutPermit Application 1985-05-13HOUSING INSPECTIUN
APPLICATION
SPRINGFTELD
7f 72.'so -Z .: s O
DATE:.r/s/s{95os?o
JOB ADDRESS: J 3{ //z_ f/. /?rs 91
OWNER trryd, so1lr.I^soo.-b. r t f.ro-f+,"{ ?r6.Lfi],r
OWNERS ADDRESS' POBO
APPLICAI{T: j<r- io.r v-or:
Pn,*rlt(-
APPLICANTS ADDRESS: LZolz il r)+r- t Or
FoR ACCESS To PRoPERTY--PLEASE IIICLUDE TELEPHoNE NIIMBER, WG -Lq\(
CITY OF SPRINGFiELT^
Department of Publ ic h ks
Bui'lding Safety 0ivision
225 North 5th StreetSpringfield, 0regon 97417
726-3753 (gus. ) tZA-3769 (Insp.)
A $30. OO INSPECTION FEE IS REQUIRED AT TIIE TII.IE OF
APPLICATION
Iil#,ITELICATION FORM MUST BE SIGNED BY THE OI^/T{ER OF THE PROPERTY TO BE
SIGNATURE OF PROP
FOR OFFICE USE ONLY
TY 0l,fNER
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
CO}O{ENTS:
RECEIPT NI]MBER:
DATE PA ID:-/\-9