HomeMy WebLinkAboutOccupancy Application 1988-3-16
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CITY OF SPRINGFIELD
ment of Planning and Dev~pment
uilding Safety Divi~
, 225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPEtllPN
APPLICATION
1.073# 8862;;:>6
DATE:""n1.a..-d.J I t.. I q 81i{
JOB ADDRES S : -3J S () E I!ffiJ./{ 5 t ....~fR, f:1;:1i E Lt) N?. "
OWNER: ()RF~ S1AiEnEf1. (jf' +tJl?edR'f ~
mVNERS ADDRESS:--3JSD E' MAIN:3.-I-. S(/If'''tfr/~L/J 1112.-. ~
APPLICANT:~ sfAf~ ~ ~F {isll ~NO llJILt)Ltrr
APPLICANTS ADDRESS: 3./':'ICJ E: t1Ail:! sf S~/Nt:.r,a 1'\
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: 7~~-~~8~
.J\",G ~w..A. t1'r 6dn": e..Q.. yi-(.tl. ..'
~ROPOSED USE:.Bas.I"tC:~~ t"iFija:s. J .~ IJ~ rr-SH ItAJ,{IJt..ir~
A $ 35.00 INSPECTION FEE IS REQUIRED AT THE TIME
~~ OF APPLICATION ~
~~ ~...I ,
THIS APPLICATION FORM MUST BE SIGNED BY THE OlmER OF THE PROPERTY TO
BE INSPECTED.
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. ~GNATURE 'OFPROPERTY OHNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
RECEIPT NUMBER:
tb7?c.,/~~ c>?e~~ #> '7'75/"7
DATE PAID: A=-/'.!""/v~ ~/.....~
DATE OF REPORT:
DATE OF CERTIFICATE OF C011PLIANCE:
COMMENTS:
e1DLf. 1:"'100
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