HomeMy WebLinkAboutMiscellaneous Application 1984-04-11CITY
Departme
Bui I di n
?25 N
Spri ngf i
726-37s3 (B
PRiNGFiELDf Public tlcfety Djvision
5th Street
0regon 97 477
726-3769 (Insp. )
OCCUPANCY I}'ISPECt rON
APPLICATION
OF Snt og sa
o rth
el d,
us. )
DATE:
JOB ADDRESS:
OWNER:
OI']}]ERS ADDPGSS
APPLICANT:
APPLICANTS ADDRESS:
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPTIONE NIIMBER Z A4L -5r+3
4- tt-r4
*4,
ct-
SPRINGFIELD
PROPOSED USE:
A $3O.OO INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OI.INER OF THE PROPERTY TO
BE INSPECTED.
SIGNATUPG OF PROPERTY Oi{NER"7f-/.^*'hy#t-.yt- nor",FOR OFFICE USE ONLY
4.O
DATE OF I}ISPECTION
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
CO}O{ENTS:
RECEIPT NUMBER:
DATE PAID:
_Upri"Vf;*/d'J)enture L'n*ter" --Vto.
I2I6 MOHAWK PLAZA
SUITED-MoHAwKBLvo.
SPRTNGFTELo. OR 9-7477
746-5 l 43
BRUCE MCBEE
TECHNICIAN
MARGARET BALLER. C.O
LICENSEO OENTURIST
JOB ADDRESS:
OWNER
OIfNERS ADDP.ESS:
APPLICANT:
APPLICANTS ADDRESS:
FOR ACCE
PROPOSED USE:
A $30. OO INS
\D30
APPLICATION
3
SS TO PROPERTY--PLEASE INCLUDE TELEPHONE NI]MBER:a t+
PECTION FEE IS REQUIRED AT THE TIMEOF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY T}IE Otr.INER OF THE PROPERTY TOBE INSPECTED.
*4,
c-
N
SIGNATUPG OF PROPERTY OI{NER
FoR oFF rcE usE W'vn'-b."**-.^,"
DATE OF I}ISPECTION:
DATE OF REPORT:
DATE OF CERTIPICATE OF CO}4PLIANCE:
COM'IENTS:
t/
-RECEIPT
NIIMBER:
DATE PAID
, Jpn;nVf;eld J-)en{wre Len/,er'/*o.APPLICATION
I2I6 MoHAwK PLAZA
SUITEO.MOHAWKBLVO.
SPRTNGFTELo. OR 97477
746-5 I 43 c,26tMARGARET BALLER. C.O.
LICENSED OENTURIST
BRUCE MCBEE
TECHNICIAN
"&,JOB ADDRESS:
0!trIsER:
OIfNERS ADDPGSS:
APPLICANT:
APPLICANTS ADDRESS:
FOR ACCESS TO PROPERTY-.PLEASE INCLUDE TELEPTIONE NIIMBER: 74L -5r+3
PROPOSED USE:
A$-a+O
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY T}IE OI.INER OF THE PROPERTY TO
BE INSPECTED.
3O.OO INSPECIION FEE IS REQUIRED AT THE TIME
SIGNATUPG OF PROPERTY OI{NER
FoR oFFrcE usE W'vnv&-r,tu.nor-
DATE OF I}ISPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF CO},IPLIANCE:
COM-(ENTS:
RECEIPT NUMBER:
DATE PAID:
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I2I6 MOHAWK PLAZA
SurTED-MoHAwKBLvo.
SPRINGFIELo. OR 9747.7
746-5 I 43
MARGARET BALLER. C.D.
LICENSEO DENTURIST
BRUCE MCBEE
TECHNICIAN
JOB ADDRESS:
O}trNER:
OIfNERS ADDP.ESS:
APPLICANT:
APPLICANTS ADDRESS:
APPLICATION
,z/:3 0
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEP}IONE NIIMBER: 74L -5r+3
*8,
ar-
PROPOSED USE:
A$
BE INSPECTED
30. 00 INSPECTTON FEE IS REQUIRED AT TtlE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY T}M OI.INER OF THE PROPERTY TO
&
SIGNATUPG OF PROPERTY OIfNER
FoR oFF rcE usE W*1n,#t-,*u",.rru
DATE OF I}ISPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF CO},IPLIANCE
CO}O{ENTS:6
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RECEIPT NUMBER:erl
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