HomeMy WebLinkAboutOccupancy Application 1987-8-20
,.
CITY Ur SPRINGrlELD
) Department of Planning and Deve.ment
. Building Safety Divisi
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPEC~
APPLICATION
SPRINGFIELD
DATE: fI Jd" Ii'?
JOB ADDRESS: Lj I. f i? m /.71 N
OWNER: :::r."'" rzJ nJ 1 nJ ;r; s 1- e t1
mmERS ADDRESS: 11- Lj':jJt)2- 0 /3 1- DC.
..
t;:; IJ r.. .'~ J?.J/..:' 4 f? fo G. 1 I 71< .
APPLICANT: /..II /1._1-1 finr
./'VI (' C-L/./.rk0:~r
APPLICANTS ADDRESS:
J / S /'1./. L/ '0... S- 7.
:;: P /?//vc:. r/~: L ~
FOR ACCESS TO PROPERTY - - PLEASE INCLUDE TELEPHONE NUMBER: '7 '-I 7 - f '7'.:J P
PROPOSED USE:
(1f-}(3/rVt71
S /-1 0 I'
A $ 35.00 INSPECTION FEE IS REQUIRED. AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OvillER OF
BE INSPECTED,
---
ERTY TO
~
)
OF P~Y
---;.
--,.
OWNER
FOR OFFICE USE ONLY
---------------------------------------------------------------------------
DATE OF INSPECTION:
RECEIPT NUMBER: le-'Ds S-
DATE PAID: <6-'2..0 -y']
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
.::