HomeMy WebLinkAboutBuilding Application 1990-06-21SPRINGFIELD
HOUSING INSPECTi.--
APPLICATION
CITY OF SPRINGFIELD
Department of Plann
Bui 1di ng Saf
2?5 North
Spri ngfi el d,
726-37s3 (Bus. )
De opment
v'i ston
reet
97477
69 (Insp.)
i ng andety Di
5th st
0regon
7 ?6-37
DATE
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JOB ADDRESS:s
owNER , 9ro/"S,/oas -,/to-{-rn/1"{
OWNERS ADDRESS 3a<, ,//jF s7,--
APPLICAIiT:2*y'r' SruZ, ,/n.&n*
APPLICANTS ADDRESS:7dZ ,/-zr4 SZ,
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER 7sZ-Zwr
A $35.00 TNSPECTTON FEE rS REQUTRED AT TIIE TrI'{E OF
APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY TIIE OhT{ER OF THE PROPERTY TO BE
INSPECTED.
Ex^-l"-- Fr[-., =l, .n^. ,-
SIGNATURE OF PROPER.TY OWNER
FOR OFFICE USE ONLY
DATE OF INSPECT]ON:RECEIPT NU}{BER:?/
DATE OF REPORT DATE PAID:h -z,t -1 o
DATE OF CERTIFICATE OF COMPLIANCE:
COIO{ENTS:
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