HomeMy WebLinkAboutOccupancy Application 1985-1-5
CITY OF SPRINGFIELD~,
Department of Public Ww.rs
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
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JOB ADDRESS: .Lf02?
OWNER: I. ) J/l.'j..I'J(}lj""'
OHNERS ADDRESS: .t!fO?' c./
APPLICANT: '~.d1 /7/ f) ~
APPLICANTS ADDRESS: ~,.pn'l
OCCUPANCY INSPE~N
APPLICATION
SPRINGFIELD
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DATE:
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FOR ACCESS TO PROPERTY -- PLEASE INCLUDE TELEPHONE NUMBER: 7<17 - 2.2.0 ~
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PROPOSED USE: A,.A..JL.1_f? PfAJ r \'//e, n ( s-h reo ;' R R,v./ I 'o.u< I')
. A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE O.mER OF THE PROPERTY TO
BE INSPECTED,
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SIGNATUP~ OF PROPERTY O\iNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
RECEIPT NUMBER: 10 q 02/
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DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
DATE PAID: