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HomeMy WebLinkAboutSpecial Inspection Occupancy 1994-6-6 ~. ,~ OCCUPANCY INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING DIVISION ::::~=====~~=~~:~=~J(===================================:::=::::::~=~=~=G=~;~ ADDRESS OF INSPECTION: ~to In,a/ltvrcl' 5/, OYNER: "5 c...f'\-i<.f- R., H-n-<.:P ;., <<) OVNER'S ADDRESS: (p '07 13, '=>T, PHONE NUMBER: 7'-11- '-Ie, 7(, 5(Jacf, (J(? , q 7) n :::~::::S ADDRESS'''" ~A-?>-<. . If,,,,, .li..1; (I,,~?l FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: 7'-1/- '-It, 7~ f).(+.>. r~.;r-;:;; M.,~\vt:) ===================================================================~~~~~iP=~~~ PROPOSED USE: N(l~frt/,~t.b'c/ (O","W1<..Y:J :5- 'I 5t'f7~-L VS-<7, A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION THIS APPLICATION FORM MUST BE SIGNED BY THE OVNER OF THE PROPERTY TO BE ~. - .------ -~ '/ ,-- SIGNATURE Or-PROPERTY OVNER FOR OFFICE USE ONLY --------------------~-------~--------------------------------------------------- DATE PAID: \C) ......\.0 -ct RECEIPT NUMBER: _1.;:5Z-.-z......! DATE OF INSPECTION: DATE OF CERTiFICATE OF COMPLIANCE: DATE OF REPORT: COMMENTS: - \f)rJW.}~(1 ) " ,