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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
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BUILDING DIVISION
DATE: "31.A'" (. \ q '"
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JOB NUMBER: p~2..S:
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ADDRESS OF INSPECTION:
OIlNER: QCA~ .l- L",; k'U'- k Ie \"'-.
OIlNER'S ADDRESS: '31Qo O,llc.l'~ (\.,\
APPLICANT: I'L (] - ile.-,,; "...... 0-- C eM; -\,
APPLICANT'S ADDRESS: 20G \ lltt"r r, ~
FOR ACCESS TO PROPERTY -- TELEPHONE NUMBER:
PHONE NUMBER: Lfl:6 - 8tl '- '(
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================================================================================
PROPOSED USE: {' ~T ~}~
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OIlNER OF THE PROPERTY TO BE
INSPEC~ \
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SIGNATURE OF PROPErTY OIlNER
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--------------------------------------------------------------------------------
FOR OFFICE USE ONLY
DATE PAID:
--------------------------------------------------------------------------------
RECEIPT NUMBER:
"2.. '2/ 5' 7
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DATE OF INSPECTION:
DATE OF CERT!FICATE OF COMPLIANCE:
COMMENTS:
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.DATE OF REPORT:
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