HomeMy WebLinkAboutOccupancy Application 1985-04-04SPRINGFlELD
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JOB ADDRESS:
OWNER:
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OT,.INERS ADDRESS 5,u _sr.-/2 7 2r>
APPLICANT:
APPLICANTS ADDRESS:
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEP}IONE NI]MBER:
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PROPOSED USE: - '-,*e--/n/
CITY OF SPRINGFIEL ,
Department of Publ i c trvrks
Building Safety Division
225 North 5th Street
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7?6- 3753 (.Bus.
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, 0regon 97477
) 7?6-3769 (Insp. )
OCCUPANCY II{SPECTION
APPLICATION
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A $30.00 TNSPECTION FEE IS REQUTRED AT Tm TrME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY TTIE OI.INER OF THE PROPERTY TO
BE INSPECTED.
SI TUP.E OF PROPERTY OI.INER
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IPT
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NI]MBEIT: '/-14IDATE OF I}ISPECTION:
DATE OF REPORT: /4'
DATE OF CERTIFICATE OF CO}{PLIANCE:
COMMENTS:
DATE PAID:
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FOR OFFICE USE ONLY