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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: