HomeMy WebLinkAboutOccupancy Application 1994-7-6
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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/VLo/' ~_/"9~y JOB NUMBER: t?J.7I~7/
ADDRESS OF INSPECTION: .~ ':"'/;~ ~b ~ ~
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>l OIINER: ~";. - _ PHONE NUMBER: j 'I & '-Lt3.1 ~
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'fo. Ol./NER' S ADDRESS: t)J 0 c: 11/l.Vl+.'tV ,'> i
DATE:
APPLICANT: _h(~ XN'd. 6f CtMJ1,Cc_
APPLICANT'S ADDRESS: B S 5 5 ~€..C-19- _f.:~ e.tN~
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: 3~6- laol ~.L W:~ ~09"~ P.w.4;;~,~
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PROPOSED USE: Cn'/~o.. $",~ kv- usei ~ O(J.ls~ /,v-(J~<:,,-re./ aMI /i'LSi>/.I
.L oC!<>-ll':, T/I.-'W>'^--!Jl ~n~,l L.rLlA STOWS
A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OI./NER OF THE PROPERTY TO BE
INSPECTED. ----
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~PROPERTY Ol./NER
FOR OFFICE USE ONLY
DATE PAID:
?~~I7Y
RECEIPT NUMBER: I~?g,,<-
DATE OF REPORT:
DATE OF INSPECTION:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
(OLS33? OSW}