HomeMy WebLinkAboutSpecial Inspection Miscellaneous 1986-1-15
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COURTESY INSPECTION APPLICAT10N
(RENTER REQUEST)
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'CITY OF SPRINGFIELD BUILDING DIVISION
DATE / -/5 - g cd ADDRESS OF INSPECTION 6M 5 d~, ~
OWNER 4a.Y-e ihrJ- . PHONE-;O. /)'/f -- d;)[)V
ADDRESS "3 ~ "7 ( 0M~/UL.!Jt I ve/
RENTER B-1UI!d ~ PHONE NO. ~ -11f6-9r3e!!J)
SIGNATURE OF OCCUPANT (RENTER)
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER ~.1 n J! I/dttrnL i ~. - b-!.t5tfpA-)
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TYPE OF DWELLING: SINGLE FAMIL~ DUPLEX 0 MULTIPLE 0
BRIEF DISCRIPTION OF MAJOR PROBLEMS:
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FOR OFFICE USE ONLY
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Date of Inspection
Courtesy Letter Sent
Notice and Order Issued To Owner
Date For Compliance
Compliance Obtained - Date