HomeMy WebLinkAboutPermit Application 1996-03-18-,
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DEV ELOPM E NT SERVI CES DE PARTME NT
OCCTIPAIICY INSPECf, ION APPLICATION
CITY OF SPPJNGPIEU) BTIII,DING DI\ISION
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225 FIFTH STREET
SPRINGFIELD, OR 97477
(s41) 726-37ss
FAX (s41) 726-368e
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orlNER: G rs$*, h *.t h f,r-,
JOB NUMBER:
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PHONE NUMBER: Vl'/-Zo
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CITY OF OREGON
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APPLICANT:
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APPLICAI'IT, S ADDRESS :lv lLt 'T' ,+,-S 1a.0w. 4zvz7
FoR ACCESS TO pRopERry - TELEPHoNE NUMBER: zzL*Vro I -Harye-1f,-7:ZA4 '^o1{;ct
PROPOSED USE:e Ca-L ^0'f 6h*/fn/<-?l/i
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A $35.00 INS ON FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OVNER OF THE PROPERTY TO BE
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FOR OPFICE USE ONLT
%73 /DATE PAID:
DATE OF INSPECTION:
RECEIPT NUMBER:
DATE OF REPORT:
DATE OF CSNTITICETE OF COMPLIANCE:
COMMENTS:
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