HomeMy WebLinkAboutSpecial Inspection Occupancy 1988-6-29 (2)
r J CITY Ur ~~HIN(jHELD
~ Department of Planning and Deve~ment
Building Safety Divisi"
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPECT~
APPLICATION"
SPRINGFIELD
~'o:tt 88057L
DATE: ;;;IJ~/c;f( ,
JOB ADDRESS: :)b/O ~;", ,r-k-t't ." St-f',~J).k(. dR
OWNER: -tJJ()r}~1'I tIi//;eV 4SftJ(';~ft.,j
mVNERS ADDRESS: r..JtJ w;/~.br tl/vJ- s,;:!e- S-O,y ,&-.ed;-/I'-//J f>f '7c)cy(f
APPLICANT: . /1,"" r;l'k/' .
APPLICANTS ADDRESS: 1~,IY, btPt sf . 5P1'0f<"~ oR
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070'!
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: ~77~~JQ~~
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PROPOSED USE: &~ f6'irt(Jl') t .
A $ 35.~INSPECTION FEE IS REQUIRED. AT THE TIME
I~~ OF APPLICATION .
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THIS APPLICATION FORM MUST BE SIGNED BY THE OvrnER OF THE PROPERTY TO
BE INSPECTED, 1\ru.wI'\M..V'rt\cye. ~ 'I ~
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. SIGNATURE OF PRWiRTY OWNER @
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---------------------_:~~-~:::~:_~~:_~~~~-------------------------~~-----
DATE OF INSPECTION: RECEIPT NUMBER: II 8'~
DATE OF REPORT: DATE 'PAID: b -do>-~
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: .: :
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