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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 llg \t\ \ 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 \ SIGNATURE OF PROPERTY O\^INER FOR OFFICE n-----A,F\" DATE OF INSPECTION:a REEEIPT NUMBER: DATE OF REPORT: DATE OF CERTIFICATE OF COMPLIANCE: CO}O{ENTS: ID t' I \ l'-D 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 *slo3\7 S+\Lt ",) N t 6tl^-(JOB ADDRESS: OWNER:(-\^F I \ 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. \ 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: