HomeMy WebLinkAboutSpecial Inspection Occupancy 1987-8-3 (2)
CITY OF SPRINGFIELe
Department of Planning and De pment
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~ON
APPLICATION
~.
DATE: A1Jtff~ ~ ;C{o1
- /I
JOB ADDRESS: -5ISD [LL.a.:t; /n...c:u:v ~ud
OWNER: fL,fJ~ rt- {f~~ J? ./Lad~k.. ,
OImERS ADDRESS: $()7JO VJ~: ~'JAUV:l",_~e
APPLICANT: IZnaA-&. ~ ~ i5~~
r:./ v '. _
APPLICANTS ADDRESS: SO 1tJ Y~<L- ~~~J~jJ
FOR ACCESS TO PROPERTY-~PLEASE INCLUDE TELEPHONE NUMBER:~ ?<,J~-t,Y'/.:i,
t2'J1.L&c..4 .!-:!'../.:'_~ ?2fp-7;,O r, Q...e~~.-f.~ '1fC(- 9ft/s'
, (/
PROPOSED USE: /3cu,IvL-..--;~f(L.
~
,.~~
"7J ....,.
A $ 35.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE mINER OF THE PROPERTY TO
BE INSPECTED.
. /) l' 'l j) (j , ,
" ~~~AA~f)./d~dlil5fl/~
If 00fl~ SIGNATURE OF PROP&.T~O\mER
-----~-----~~-----~~~-~~~:~:_~~:_~~:~----------------------------------
DATE OF INSPECTION:.
DATE OF REPORT:
RECEIPT NUMBER:
DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: