HomeMy WebLinkAboutBuilding Application 1984-05-29DATE:
JOB ADDRESS:
OWNER:
OI{NERS ADDPJSS:
APPLICANT:
APPLICANTS ADDRESS:
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEP}IONE NI]MBER:
./'{
PROPOSED USE:
CiTY OF SPRINGFIELD )
Department of Public tl ks
Bui 1 di ng Safety Di vi s r on
2?5 North 5th StreetSpringfield, 0regon 97477
726-3753 (Bus.) tza-3769 (Insp.)
OCCUPANCY INSPEI ON
APPLICATION
rv
SPRINGFIELD
A $3O.OO INSPECTION FEE IS REQUIRED AT TPE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY TI{E OI.INER OF THE PROPERTY TO
BE INSPECTED.
S TURE PROPERTY Oi^INER.
FOR OFFICE USE ONLY
I
DATE OF IIISPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COI{PLIANCE:
CO}OIENTS:
RECEIPT NIll,lBER , (, Z 74
DATE PAID . ,,-27*/
&l
DATE:
JOB ADDRESS:
OWNER e
OI.INERS ADDP.ESS:
APPLICANT:e-
APPLICANTS ADDRESS
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEP}IONE NT]MBER:
PROPOSED USE:
CITY OF SPRINGFIELD ,
Department of Publ ic l.l ksBuilding Safety Divisi .r
225 North 5th Street
Spri ngfi el d, 0regon 97 477
726-3753 (Bus. ) 7?6-3169 (tnsp. )
OCCUPAI{CY INSPE( )N
APPLICATION
SLtoi>l SPRINGFIELO
A $30.00 TNSPECTION FEE rS REQUIRED AT THE TrME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY TI{E OI.'NER OF THE PROPERTY TO
BE INSPECTED.
S TUPG PROPERTY OI{NER
FOR OFFICE USE ONLY
-?
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$ oaru or rlrspECrroN:
,I DATE OF REPORT:
t oers oF cERTTFTcATE oF coMpLTANCE:
RECEIPT NIMBER:€224>
DATE PAID , ,f -27-r
I
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