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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 ,. 070'! FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: ~77~~JQ~~ /IJ..&u./1' /J'Pl' ~Il' J1fb~r; J /;it Glff./' W~I'?- 1'/';"e PROPOSED USE: &~ f6'irt(Jl') t . A $ 35.~INSPECTION FEE IS REQUIRED. AT THE TIME I~~ OF APPLICATION . It Jlr' , THIS APPLICATION FORM MUST BE SIGNED BY THE OvrnER OF THE PROPERTY TO BE INSPECTED, 1\ru.wI'\M..V'rt\cye. ~ 'I ~ hl~Jj;~ . SIGNATURE OF PRWiRTY OWNER @ (pI; ---------------------_:~~-~:::~:_~~:_~~~~-------------------------~~----- DATE OF INSPECTION: RECEIPT NUMBER: II 8'~ DATE OF REPORT: DATE 'PAID: b -do>-~ DATE OF CERTIFICATE OF COMPLIANCE: COMMENTS: .: : _ "'. \ L:)' i:JO 0 v,e. ,