HomeMy WebLinkAboutOccupancy Application 1993-12-23
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE: 1:1;;'1>/'1.3 l//(1..'/ JOB NUMBER: q31~~D'
ADDRESS OF INSPECTION: ~ maU'L~~_~
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OlJNER: fJ1 T I I kc.- PHONE NUMBER: ?1P7 -Sl)",
OlJNER'S ADDRESS: Ptr~ U99 /5ttLt.nt. 0lZ 91~tf7
- APPLICANT: lL2.w,(f.1\ B"/l.f\ltVG l1nlACTS - ClI~15 /l1A.~TOtV hU;-117B)
APPLICANT'S ADDRESS: 4r=jPJc( HOUI{ Sr SPN.JGtltLf'l DR T7V79->
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FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: BOA)/ylf Ail kef! - R Rok (;1(
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PROPOSED USE: WA~f/bA<:'l- AAlb [iBl?i{AUOfo,J S/hP FbR LtMLEAu6f: 5TttL
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OYNER OF THE PROPERTY TO BE
INSPECTED, ----
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FOR OFFICE USE ONLY
DATE PAID:
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RECEIPT NUMBER:
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: