HomeMy WebLinkAboutOccupancy Application 1985-3-6
CITY OF SPRINGFIEL& '
Department of Public l.s
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSpJlltON
APPLICATION
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DATE: ~-~ -??~
JOB ADDRESS: 30 I 0 \It..to.'llA. 'S k
OWNER: TlOh RelV'lll/Lv1c1
OIo/NERS ADDRESS:/<6tofs' PiINLTrot~ L~ ~FI\ArV\~v- I ("1i'"J'
APPLICANT: -::so~,^ 8arYleS
APPLICANTS ADDRESS: 0dl ~W~lL.J-. bc:..v..v, la..-.t-EL"J~JnY'. Q74-ol
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBE~: ~.c; S-~ :a {J cy J?
Ih)bf2C!/~ ~ /:'36 p 4-4, rh'dou, UfI:rri :?"M.
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PROPOSED USE: l~~ Q~-ViIII.lvlA\A (2aJ",..-":J I'P/~~f
A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION .
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THIS APPLICATION FORM MUST BE SIGNED BY THE O,mER OF THE PROFERTY TO
BE INSPECTED.
SIGNATUP~ OF PROPERTY Olo/NER
FOR OFFICE USE ONLY
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DATE OF INSPECTION: RECEIPT NUMBER: 0cjr3 6 ,
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DATE OF REPORT:
DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: