HomeMy WebLinkAboutMiscellaneous Application 1990-04-20CITY OF SPRINGFiELD
Department of Planning anc-Oeveropment
Bu'i lding Safety D s', ,
225 North 5th StreetSpringfield, 0regon 97477726-3753 (Bus. ) 726-3769 (Insp. )
DATE
JOB ADDRESS:1b63 N, lLfL .eP(u O lrqan
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owNERS ADDRESS , l6m MOhAt,'l Btd
APPLICAI{T: 71
APPLICANTS ADDRESS: 37OO OTZ 0r\I
FoR ACcESS ro pRopERTy--pLEASE rlrcLUDE TELEpHoNE NIMBER , lqGLl)14
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HOUSING INS} -'IC
APPLICATION
SPRINGFIELD
A $35.00 TNSPECTTON FEE IS REQUIRED AT TIIE Til.IE OF
APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY Ti{E Oh'}IER OF THE PROPERTY TO BE
INSPECTED.
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SIGNATURE OF PROPERUY OWNER
FOR OFFICE USE ONLY
DATE OF INSPECTION
DATE OF REPORT
DATE OF CERTIFICATE OF COMPLIANCE:
COIO{ENTS:
RECEIPT NU}{BER:
DATE PAID:
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