HomeMy WebLinkAboutSpecial Inspection Occupancy 1990-8-31
CITY OF SPRINGFIELD
Department of Planning and Deve~ment
Building Safety Divisi'"
225 Noffh 5th Street
Springfield, Oregon 97477 .,
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPEC~
APPLICATION
SPRINGFIELD
~ c, 0 I () C>J').
DATE:~. '6 \ \ 19'1O ('l~2. lZ. J( 02.2.0(
JOB ADDRESS: 4 z.. 7 0 ~,M.a..:, n. ~ -\-. I <~ .:. \~~" \& ~.
. ~ "
OWNER: jI,Aqt.;Z,,/ ~~ -r' C~(3UrS ~~, l
mmERS ADDRESS: 6t'Jo ~~i 1Z':-,S-~ ,~.J ~'C,fQ'>!, ~I/
APPLICANT: -So L, 'Fi-d~' t\..-
~
APPLICANTS ADDRESS:
1'1'-
J'
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:~ ~ ~
f?~,>< ",pBi?;;l1/1'A7'i-A rT )J/5.<rA~ (.5'&3 m'u-;e, I '
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PROPOSED USE: OI7"7d& f ft>>JtJ PA?#JKQ:T' ~e/f' ; "f:YC~,~r
A $ 35.00 INSPECTION FEE IS REQUIRED, AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OvlliER OF THE PROPERTY TO
BE INSPECTED.
~AP~~ ILn'
SIGNATURE OF PROPERTY mmER ~ ~
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
RECEIPT NUMBER: / ~ /;Y 7 '
DATE PAID: <j?>-5/-fO #~~
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: