HomeMy WebLinkAboutSpecial Inspection Miscellaneous 1986-4-23
CITY OF SPRINGFIELD.
Department of Planning and Deve pment
Building Safety Division .
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
HOUSING INSPECTIO~
APPLICATION
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SPRINGFIELD
JOB ADDRESS:)( 1ot..5?cJ ~
OWNER:'" l..{) p-,,- I ~ (AJ f(D; fft ma.d(~",,('),t/ J'OA.<.J c. (;.J ,'ICO)( i: .
OWNERS ADDRESSY. 1-/~~ -111{>C1J>,,~.d (!(')U i-+ ~~ / ~
APPLICANT: ~..t.Jf./ 0.,uM/J)./'JM..J 40 (J.M11f)
APPLICANTS ADDRESS: 6 k g-i! LJ1ffil J:'",-" S;a; fi1 .
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE N~BER: -;qh - /t;/t%
c:n?/(,t.. ji)fkJ I)~r:.- L/f'2"1 4J'/A IA/~~ ?V... ~."'b";
A $35.00 INSPECTION FEE IS REQUIRED AT THE TUm OF
APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE
INSPECTED,
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SIGNATURE ~F PROPERTY OWNER I
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'P ;J /J1
FOR OFFICE USE ONLY
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COl1MENTS:
RECEIPT NUMBER: If /r; t 3.3 S-
DATE PAID: 4-,;LC(-?.6