HomeMy WebLinkAboutOccupancy Application 1983-10-7
CITY OF SPRINGFIELD'"
Department of Public W~s
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~N
APPLICATION
SPRINGFIELD
8~\\q
DATE: /0-7- ~-3
JOB ADDRESS: 4/01> f '-/11:1- '-777,."',, .2.J.
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4.0; /nlllR. q 7'177
OWNER: 1=R"M.R .'7f,1~r
OHNERS ADDRESS: 5,?J ~ru__ it .toi/,.! (),('Q7'i77
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APPLICANT: ~.',... ~ ~LbiZ.Jt..l_ {:rucU.s
APPLICANTS ADDRESS: 4..55'-1 {!Q..n\..d.U~ Sf- ~CJI.{,J oR. q 7,/77
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FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:
~: 7:J./':i;l./.;l- ol2-1 ~2.t ~ 7'/6?50b
PROPOSED USE:. LI. <:, ~ (!u..R., 'z'o-f f Oth(-.",
A $30.00 INSPECTION FEE IS REQUIRED, AT THE TIME
OF APPLICATION '
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THIS APPLICATION FORM MUST BE
BE INSPECTED.
SIGNED BY THE OvrnER OF THE PROPERTY TO
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SIGNATUP~ OF PROPERTY ~
FOR OFFICE USE ONLY
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DATE OF INSPECTION:\O- \ ~ - R~
DATE OF REPORT:
RECEIPT NUMBER: \.o\~ \ U
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DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE: ... _ ~ \~
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