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:
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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.
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SIGNATUP~ OF PROPERTY OIVNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION: RECEIPT NUMBER: f3. 05r / I
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DATE OF REPORT:
DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: