HomeMy WebLinkAboutOccupancy Application 1996-2-26
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DEVELOPMENT SERVICES DEPARTMENT
225 FIFTH STREET
SPRINGFIELD. OR 97477
(541) 726,3753
FAX (541) 726-3689
OCCUPANCY INSPECTION APPLICATION
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DATE: -&1'< '7~. ,:;- },~ JOB NUMBER: 960:2.,,.-v
ADDRESS OF INSPECTION: '-/'7'.::::>5 -I YW_~ /W-f"(~ ~.Y ~
mINER: ~~~?ZA;1 / /J?;7Ift,<?~ _ PHONE NUMBER: 7".s~20~
OIlNER'S ADDRESS: '2:5"'// L/ {yo ..4'yJ;:-;Et!:,.r~~ ~- "7:/. 9""~
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APPLICANT: v./FA77>~ (~~0L&=" I ?l/7-67/'-/
APPLICANT'S ADDRESS: 2/'-/.') NfEf:. 7~/?/: ~,5?> ~
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FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: ~~':7-'~ ,~~
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PROPOSED USE: R~A,t!f>~/r /,F~;5' ~C'~ r~ ~~~~/"~
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
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THIS APPLICATION FORM MUST BE SIGNED BY THE OIlNER OF THE PROPERTY TO BE
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SIGNATURE OF PROPERTY OIlNER
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FOR OFFICE, USE ONLY
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DATE PAID: --:?" 2~. "9?:
DATE OF INSPECTION: '2- '2 k ~ez:
DATE OF CERTiFICATE OF COMPLIANCE:
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RECEIPT NUMBER: ~~ /2'7>
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DATE OF REPORT: ? -:'2.. ~.~::': ,
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COMMENTS:
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