HomeMy WebLinkAboutOccupancy Application 1985-8-28
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Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
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JOB ADDRESS: - / 3,6&/ m#/,1) ~REET
OWNER: I HE 11l11//J 1/ E/f./YURe ~ ). --J:7i1P/I/EJ/17AJ<~ _ (
OHNERS ADDRESS: -3 I;>' ;::3A--ST 1'.3 T.t:L E;L!.-{;,'
APPLICANT: RtOLLIE . -K'~/?/,{/6~.
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.. APPLICANTS ADDRESS: ~_ '7 '- a { fC c;. L
DATE:
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:
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PROPOSED USE: t-/~flT A/{/I-)JUFk_rl../R /1//'; tOF M-fi}~?t/.'S
A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION .
THIS APPLICATION FORM MUST BE SIGNED BY THE OllliER OF THE PROPERTY TO
BE INSPECTED.
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SIGNATURE OF PROPERTY OI-lNEL<. r .
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
RECEIPT NUMBER: g CoG:20 J
DATE PAID: X>-,Q\(- 85"
COMMENTS:
OUR
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