HomeMy WebLinkAboutPermit Application 1984-04-09tqcas
CITY
Departme
Bui I di n
225 N
Spri ngf i
726-37s3 ( B
PRINGFIELD )f Public 'ksfety Divisron
5th Street
0regon 97 477
726-3769 (Insp.)
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DATE:/.- 7- tr'
JOB ADDRESS fJ-d - f
owNER, ' 74 Lar-r' hr4e-lq j*u{ 6
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OI{I{ERS ADDPGSS
APPLICANT:
APPLICANTS ADDRE SS: I T5 7 /- S r
qr '7 r/t/
a,-
FOR ACCESS T0 PROPERTY--PLEASE INCLUDE TELEPHONE NIIMBER: '72/7- $2 6 oW
PROPOSED USE:
OCCUPANCY I}JSPL ION
APPLICATION
SPRINGFIELD
A $30. OO INSPECTION FEE IS REQUIRED AT TLIE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE S]GNED BY T}IE OI.INER OF THE PROPERTY TO
BE INSPECTED./ r;-z
S TUP.E PROPERTY
FOR OFFICE USE ONLY
6
RECEIPT NI]MBER:(.r,a1a3DATE OF I} SPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF CO},IPLIANCE:
COMMENTS:
DATE PAID:
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