HomeMy WebLinkAboutPermit Application 1987-05-19CITY OF
Department of Pl
Building S
225 NortSpringfield
726-3753 (Bus.
SPRINGFiELD
anning and Devafety Divisiunh 5th Street, 0regon 97477
) tz6-31 69 ( I ns p. )
pment HOUSING INSPECTI(
APPLICATION
SPRINGFIELD
DATE:S-\ 6- g1 #slo3\7
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JOB ADDRESS
OWNER.:c-\^
OWNERS ADDRESS:
APPLICAI{T:
APPLICANTS ADDRESS:
F
€_
FOR ACCESS TO PROPERTY--PLEASE II]CLUDE TELEPHONE NUMBER:
A $35.00 INSPECTION FEE IS REQUIRED AT TI{E TIME OF
APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY TI{E OU{'I{ER OF THE PROPERTY TO BE
INSPECTED
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SIGNATURE OF PROPERTY O\^INER
FOR OFFICE
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DATE OF INSPECTION:a REEEIPT NUMBER:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
CO}O{ENTS:
ID
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CiTY OF SPRINGFIELD
ng and Dev. Jpmentty Divisionth Street
niDepartment of Plan
regon 97477
26-37 69 ( I ns p. )
Building Sa
225 North
Spri ngf i e'l d,
726-3753 (eus. )
fe
5
0
7
DATE:-Sal
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OWNERS ADDRESS:,%
APPLICAI{T S o--rnt--€-
APPLICANTS ADDRESS:
FOR ACCESS TO PROPERTY--PLEASE I}ICLUDE TELEPHONE NI]MBER . 14 C-_=>7O
HOUSING INSPECTION
APPLICATION
SPRINGFIELD
A $35.00 INSPECTION FEE IS REQUIRED AT TIIE TII.IE OF
APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY TI{E OhT{ER OF THE PROPERTY TO BB
INSPECTED.
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SIGNATURE OF PROP TY OI^INER
FOR
DATE OF INSPECTION:
DATE OF REPORT:
5/7 NU}{BER
DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE
COIO{ENTS: