HomeMy WebLinkAboutPermit Application 1989-04-10DATET +-)t'37
JOBADDRESS: JAT JO, 4I 4 JPre r,.t b F tELD
OWNER: Jo *. f.ru* * ,
1'74-Sy31/?+ dUEELER RD, PtEEseyr /,".
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APPLICANTS ADDRESS:
SPRINGFIELDCITY OF SPRINGFIELD
Department of Planning and De' 'opment
Bu'i'l d'i ng Sa
?25 North
Spri ngfi el d,
726-3753 ( sus. )
fety D
5th s
0rego
726-3
i vi s _,ntreetn 97477
769 (Insp. )
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CNIESP
APPLICATION
F ACCESS TO PROPER --PLEASE INCLUDE LEPTIONE NI]MBER, 1 4,?_ 3.5 ,I+
PROPOSED USE:
A $ 35.00 INSPECTION FEE IS REQUIRED AT TFIE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OIJNER OF THE PROPERTY TO
BE INSPECTED.
c-it-
SIGNATU OF PROPERTY Oi{NER.
FOR OFFICE USE ONLY
RECEIPT NI]MBER:t3s+sDATE OF I}ISPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF CO}{PLIANCE
COMMENTS:
DATE PAID:+tD-gq
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OI.INERS ADDP.ESS:
APPLICANT: