HomeMy WebLinkAboutPermit Application 1985-08-12CITY
DePa rtme
Bui I d'i n
2?5 N
Spri ngf i
726-3753 (B
SPRINGFIELDof Pub
afety
h 5th, 0reg
) 726-
c .rks
V --r OII
reet
97477
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SPRINGFIELO
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JOB ADDRE
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enrE*s ADDRESS:
APPLICAI{T:
APPLICANTS ADD S:
FOR ACCESS TO PROPERTY-.PLEASE IIICLUDE
2 -/o
NUMBER
A$30. 00 TNSPECTIoN FEE IS REQUIRED AT THE TIl,tE OF
APPLICATION 7
THIS APPLI
INSPECTED.
CATION FORM MUST BE SIGNED BY THE OhT{ER OF THE PROPERTY TO BE
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SIGNATURE OF PROPER-TY OWNER
FOR OFFICE USE ONLY o 8r{
DArE OF TNSPECTTON: igr'-?E{ 2:- nr?, RECETPT NUMBER G7-
DATE OF REPORT DATE PAID
DATE OF CERTIFICATE OF COMPLIANCE
COM}{ENTS:
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HOUSING INSPEC N
APPLICATION .-t
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CITY
DePa rtme
Bui I di n
225 N
Springfi
726- 3753 ( B
PRINGFIELDf Public 'orks
fety Di v _- i on
5th S treet
0regon 97477
726-3769 (lnsp.)
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SPRINGFIELO
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APPLICAT{T:
APPLICANTS
HOUSII'iG INSPE lN
APPLICATION
.Y
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ADD S:
FOR ACCESS TO PROPERTY--PLEASE I}ICLUDE NUMBER:
A$30. 00 INSPECTION FEE IS REQUIRED AT THE TII,{E OF
APPLICATION
THIS APPLICATION FOR},I MUST BE SIGNED BY T}IE Oh'NER OF THE PROPERTY TO BEINSPECTED.
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SIGNATURE OT PROPERTY OWNER
FOR OFFICE USE ONLY ,9t{
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
CO}O,IENTS:
t-lf- fg RECEIPT NUMBER:G
3-/5-ac DATE PAID z-{s-
DATI:
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CITY OF SPRINGFIEI,D
Department of Publ i, 'orks
Building Safety Div."ion
2?5 North 5th Street
Spri ngfi e1 d, 0regon 97 477
726-37s3 (Bus.) 726-3769 (Insp.)
HOUSING INSPEUTION
-
APPLICATION
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JOB ADDRE
OWNER.:aqlf,J
erhERs ADDRESS:
APPLICAT{I:
APPLICANTS
FOR ACCESS
-/o
ADD
TO
S:
PROPERTY-.PLEASE I}ICLUDE NI]MBER:
a
A$30. 00 TNSPECTIoN FEE rS REQUTRED AT THE T]I.{E OF
APPLICATlON
THIS APPLICATION FORM MUST BE SIGNED BY THE Oh'NER OF THE PROPERTY TO BE
INSPECTED.
48s^ e?/
SIGNATURE OF PROPER.TY OI,TNER
FOR OFFICE USE ONLY o 8r{
DATE OF INSPECTION:
DATE OF REPORT:
8-tr*s RECEIPT NTIMBER:
DATE PAID:
(-
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DATE OF CERTIEICATE OF COMPLIANCE:
COM}{ENTS:
SPRINGFIELD
DATT:
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