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HomeMy WebLinkAboutOccupancy Application 1985-8-8 CITY OF SPRINGFI. . Department of Publi~orks Building Safety Division 225 North 5th Street Springfield, Oregon 97477 726-3753 (Bus.) 726-3769 (Insp.) .I'::f 6 t, ~,' t1 \ Ob4-Wf 56 f I z, JOB ADDRESS: 4'03'f 1??a./... 5' t:)l--.~.r.'t/lj '1\ j OWNER: U.e.sTol.7-ev C,,"1 5 1'....,: .... Tv::"", Go ' t' mVNERS ADDRESS: '-10:3 Cf fr7q.'vr "'-- 41 APPLICANT: /-!v/)/?A-IfL/C' ~/J1Ae!l;Alt:. )'E/(Vl(]E5 rNe.. ~ APPLICANTS AD;RESS: {jO'3 L{. MA-l N ~, \If DATE: <6 /<6/ ~S- ,I." .;' FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: )Q'7-<1'J71 PROPOSED USE: /ly~IlVLt~' {'fJmfJ<1A1eAlf /(EfJ/i-11( A-N() 6~/Jel(J/L m~H/NE. wotek A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION ' , , THIS APPLICATION FORM MUST BE SIGNED BY THE OllliER OF THE PROPERTY TO BE INSPECTED. 7f2L ~~ SIGNATUP~ OF PROPERTY OIVNER FOR OFFICE USE ONLY --------------------------------------------------------------------------- DATE OF INSPECTION: RECEIPT NUMBER: f3. 05r / I ~-y-rS- DATE OF REPORT: DATE PAID: DATE OF CERTIFICATE OF COMPLIANCE: COMMENTS: