HomeMy WebLinkAboutSpecial Inspection Occupancy 1987-8-3
CITY OF SPRINGFIELO
Department of Planning and De~pment
Building Safety Divis~n
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~ON
APPLICATION
SPRINGFIELD
DATE: A-utiua.3, ;CfS1
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JOB ADDRESS: .5/56 E.A.A.:t: c..-;n~ ~
OWNER: ~A~ ~~~ J?Aci~ .
OIVNERS ADDRESS: .$OlJo VJ~ I ~/U~lf;U
APPLICANT: Il~~ ~ ~ ~
APPLICANTS ADDRESS: 00?t? y~ ~J.fl
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:~, ?~~-(.q~
/J/J?~;"~..L 7...1~-7d.Or, ~~ 'IrC;-97r1.s
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PROPOSED USE: 13~
, (9
A $ 35.00)INSPECTION FEE IS REQUIRED AT THE TIME 10 /
\.. OF APPLICATION .
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THIS APPLICATION FORM MUST BE SIGNED BY THE OvmER OF THE PROPERTY TO
BE INSPECTED. ,;. ~ <.,.,
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If bC/t1;){) SIGNATURE OF p~mVNER
--------~----_:~~-~:::~:_~~:_~~~:_---------------------------------
DATE OF INSPECTION:
DATE OF REPORT:
RECEIPT NUMBER:
DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
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