HomeMy WebLinkAboutOccupancy Application 1991-9-26
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE: g/tl..folq/ JOB NUMBER: CfIII':tJ
ADDRESS O/INSPE:rION: _ ~ /_';-0 ;v/d1A1 5'/ .5 &J.NCfJELD
OIINER: OREGo/J IJE-"Aftfi!1FJ./T t)~j!~?:~ER:/,,2.t-3SfY
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OIINER'S ADDRESS: 3/S/J JvfIlIA.!..SZ;, Ci)tJL!i?fr;--Pu"!.Jd
APPLICANT: ~ltdr/e5 f) &wlsbcf *.
APPLICANT' S- ADDRESS: 3Jc5l? /vIJ/-)jj S.I, ' "5P'RJtlG{ie-J...ct
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FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: 7;2 6 -3 Sl?'X"
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PROPOSED USE: r7mrE - 11/0/\/ /Uhtc.. /J'rcess;
A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OYNER OF THE PROPERTY TO BE
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SIG ATURE OF PROPERTY OIINER I
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FOR 'OFFICE USE ONLY
'DATE PAID:
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RECEIPT NUMBER:
2-14-z..5
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: