HomeMy WebLinkAboutOccupancy Application 1990-11-9
CITY OF SPRINGFIELO
Oepartment of Planning and oeVlment
Building Safety Oivis
225 North 5th Street
Springfield, Oregon 97477 -.
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPEC4IIN
APPLICATION
SPRINGFIELD
DATE: () O\) t'mDo---...r
JOB ADDRESS: 4J 1 '1 '5>c.),.,; +p _ f ffio3 (\ stv-ee+--
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mVNERSADDRESS: ~d-.\\ """t:,'\ \'V\'A\N <":"
APPLICANT: !JQ,\/)(w"cLh m Irh(lJlp, 6-e_'(Y~
APPLICANTS ADDRESS: 4L(oI/~ N, ~g;th soRci
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FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: lQlo -5447
PROPOSED USE: D ~ (' 0,. '("~ C-..P \'\ W,r---
A $ 35.00 INSPECTION FEE IS REQUIRED. AT THE TIME
OF APPLICATION -
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THIS APPLICATION FORM MUST BE SIGNED BY THE. ER OF THE PROPERTY TO
BE INSPECTED.
FOR OFFICE USE ONLY
A~4LL MI1-d4-~~(L
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DATE OF INSPECTION: 1/ q, q{)
DATE OF REPORT: .I ( , .I LI? ,Cj()
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: 1#~ ~1"'S rAiJlA"';>~.c..,.".. ,4 ..t'-"""'..</7"/~"" Or-...-'YC~
RECEIPT NUMBER: 1R~9-2
DATE PAID: JJ-&;-9t::::>