HomeMy WebLinkAboutOccupancy Application 1984-3-23
'.. . -. C I TV 0 F S P R I N G FIE L . '
Department of Public l ks
Building Safety Division
225 North 5th Street
Springfiel&, Oregon 97477
726-3753 (Bus,) 726-3769 (Insp,)
DATE: ;J,/-i'/?d J 7- <f'~
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JOB ADDRESS: ,'7'7 t2a ~,~
OCCUPANCY INSPE~ON
APPLICATION
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OWNER: /5 ~A/7~__' /Y. /;?' ~_ ~'':.. " /
OHNERS A~DRES~ ;,; c/ f A/ ~ ~ n /~;.. ~,~ r/",:~~U', ~~'
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APPLICANT: /~....__ /~'~, /?Y .f::. _ _~. e:?
APPLICANTS ~~~: ib y /" ~ AI ~- /7--",,~r/ /4 -"~ . .=,d.u~~u . t'PAP,
FOR ACCESS TO PROPERTY -- PLEASE INCLUDE fu;PHONE NUMBE; ;79/C - f.> 5"/
PROPOSED USE:
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A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OvlliER OF THE PROPERTY TO
BE INSPECTED.
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SIgN.ATUP~ OF PROPERTY OIVNER '
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COHPLIANCE:
COMMENTS:
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RECEIPT NUMBER: & eLolA
DATE PAID: Ur\\C. 2<3 \o..Rl\
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