HomeMy WebLinkAboutPermit Application 1990-01-19DArE: /-/?- g7
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APPLICANTS ADDRESS:z S
FoR ACCESS To PROPERTY--PLEASE INCLUDE TELEPIIONE NUMBER, 7L{ t* 3O lZ^
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PRoPosED usE: Cbb,;J SA op
CITY OF SPRINGFIELD
Department of Planning and P pment
Building Safety Div,"t,.rn
225 North 5th StreetSpringfield, 0regon 97477
726-3753 (Bus.) 726-3769 (lnsp.)
OCCUPANCY I].JS: i\
APPLICAT]ON
SPRINGFIELD
A $ 35.00 II{SPECTIoN FEE IS REQUIRED AT TTIE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OI.]NER OF THE PROPERTY TO
BE INSPECTED.z&-M
SIGNATURE OF PROPERTY OI{NER,tn \t-L
FOR OFFICE USE
RECEIPT NTMBER:fB"DATE OF I}trSPECTION:
DATE OF REPORT:
DATE OF CERT]FICATE OF CO},IPLIANCE
COMMENTS
DATE PAID:D
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