HomeMy WebLinkAboutSpecial Inspection Correspondence 1981-8-27
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HOUSING INSPECTION APPLICATION
EXISTING BUILDINGS
CITY OF SPRINGFIELD
BUILDING DEPARTMENT
DATE:
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JOB ADDRES S : .$i?? tf (P m ft 1 tV
OWNER: -r@ M. 1-.- A ~ &F
OWNERS ADDRESS: J 7 '-19 rn ~ I/J ST
APPLICANT: leM /""A ~(;-F
APPLICANTS ADDRESS: SIfM t:
NUMBER OF UNITS: I
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FOR ACCESS .TO PROPE:;d-2ASE INCLUDE T~LEPHONE N~ER.:
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~ A $24.00 INSPECTioN FEE IsVREQUI~(;.HE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE
INSPECTED.
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SIGNATU~ OF'PRQPE~Y OWNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION: 0.- ~-~\
REMARKS:
DATE OF CERT. OF COMPLIANCE:
RECEIPT NUMBER: E\~ \ 1ln
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DATE OF REPORT:
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