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HomeMy WebLinkAboutPermit Miscellaneous 1996-6-21 I 0 @fUlJ~~ @Eill@l] DCYCWI'MENT :;[I/IIICCS /)[f'MITMCNT "SP'R_~IELi": ". " I' I~ l ~ $1\:1 "J ;>;>5 FIFTII 8m!'rT . ~;I'I/lNl;I-IU{). ()/I 91.111 (54 I) 72G,.175.1 F/lX (5.11) 72G..JGIJ9 '. OCCUPANCY INSPECTION APPLICATION CITY OF SPRINGFIELD acccaae========================================================================= BUILDING DIVISION DATE: "31.A'" (. \ q '" 11~ b III ~ S- Vi'1".r \cd- oS ~ . JOB NUMBER: p~2..S: SPrI"'I.J h-e. i() d-{\ 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 '- '( Af_OoN. rM C,0'/.(J) I .. G)<"c.-c~ '). 1+r;.,re.6 ~ bcon""" (fR. 117'10) ,', ~IL-b)67 ~~ ================================================================================ PROPOSED USE: {' ~T ~}~ { " 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~ \ \ ~ (ygr"" SIGNATURE OF PROPErTY OIlNER ,'" -------------------------------------------------------------------------------- FOR OFFICE USE ONLY DATE PAID: -------------------------------------------------------------------------------- RECEIPT NUMBER: "2.. '2/ 5' 7 ~/.2~/G. DATE OF INSPECTION: DATE OF CERT!FICATE OF COMPLIANCE: COMMENTS: . . '.~" .DATE OF REPORT: ~. ,. .' ~[?R@~@~[E[Q) ~[L@@~ ~[L~OO ~[E@uno~[E[Q) ~'IT' 1JO~~ @~ &~.fp)ri:o~~1JO@OO