HomeMy WebLinkAboutOccupancy Application 1989-2-14
CITY OF SPRINGFIELO
Department of Planning and De~opment
Building Safety Divi~n
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE4IkON
APPLICATION
SPRINGFIELD
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mVNERS ADDRESS: ~/ ;Co/I:""
APPLICANT: ~r;.; S &05
APPLICANTS ADDRESS: 3r>C)f=')
DATE:
2 - /Cj- 89
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JOB ADDRESS:
OWNER:
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NUMBER: 72 i' - r;,7 S- C-
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE
PROPOSED USE:
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A $ 35.00 INSPECTION FEE IS REQUIRED AT
OF APPLICATION
THE TIME
9-01
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PROPERTY TO~~~_
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THIS APPLICATION FORM MUST BE SIGNED BY THE OlmER OF THE
BE INSPECTED,
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FOR OFFICE USE ONLY
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SIGNAT~OF PROPERTY OHNER
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DATE OF INSPECTION:
RECEIPT NUMBER:
(3^-//)
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DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
DATE PAID:
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COMMENTS:
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