HomeMy WebLinkAboutOccupancy Application 1987-03-27SPRINGFIELD
#7ro2o7DATE:1
JOBADDRESS: I*IA P. Iff,57
OWNER:leu-i
OT,{NERS ADDRESS:s-? fooo ".1 +<,4
-APPLICANT:c
APPLICANTS ADDRESS:4-
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEP}IONE NI]MBER, 3'{'T-1OI A
PROPOSED USE:RIP Zo.ae 4,.a €€t c<{-a S {-
r
nt of Planning and De'- lopment
Bui'l di ng Saf ety Di vi > . on
??5 North 5th Street
Spri ngfi e1 d, 0regon 97 477
726-37s3 (Bus.) 726-3769 (Insp.)
CITY OF SPRI NGFIELD
Departme OCCUPANCY INSPL .ION
APPLICATION
A $ 35.00 INSPECTIoN FEE IS REQUIRED AT THE TIME
OF APPLICATION
TI{IS APPLICATION FORM MUST BE SIGNED BY THE OI.INER OF THE PROPERTY TO
BE INSPECTED.
G.>-p-.1V ariTr- p.sa,er o.(L fi.qor,.1
4or
SIGNATUP.E OF PROPERTY OI^INER
FOR OFFICE USE ONLY
DATE OF I}ISPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
RECEIPT NI]MBER:
DATE PAID:3-2-741
del(FIRE DEPARTMENT INSPECTION
OCCUPANCY NAME CLASS
b SPRTNGFIELD
ADDRESS I BUS. PHONE
OCCUP. NAME e HOME PH.c d
BUILDING OWNER PHONE
ADDRESS
CODE SECTION VIOLATIONS
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YOU ARE HEREBY NOTIFIED TO CORRECT THE ABOVE VIOLATIONS WITHIN OAYS.
SIGNED:VIOLATIONS: Noted
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