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HomeMy WebLinkAboutOccupancy Application 1979-1-31 OCCUPANCY INSPECTION APPLICATION 0-2- 2163 ~~ .~ EXISTING BUILDINGS CITY OF SPRINGFIELD BUILDING DEPARTMENT DATE: 1-3/-79. 4 / t!J~ _ JOB ADDRESS: ~ / ~/.', rn.~ ,'" Si. _ OWNER: J P R ~I ~Jf", .ll\. e.J. d~,\> f.L . ADDRESS: APPLICAN'~?W')~(\ ""~ ~--1~ADDRESS:J.o,-1G_~_~~, ::\.C. (~.. FOR ACCESS TO PROPERTY - TELEPHONE: ~ - 3~ C-. f) If\.~ L!::L/ -~()QO .~~/ NU~lllER OF~ye. ~ ~ \ m\'\ 2!r.3l) A $20.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROEPTY TO BE INSPECTED * A, . // ciiffif{:.::!:// ~//..::.~ ? -v- ~ ...-::._ SIGNATURE F PROPERTY OWNER- FOR OFFICE USE ONLY ------------------------------------------------------------------------------------- Date of Inspection: Date of Cert. of Compliance: Date of Report: Receipt Number: RHIARKS: yio ~ (fltuVJL 'I f4>, . . . r;