HomeMy WebLinkAboutOccupancy Application 1988-3-16 (2)
-- - - -
i- ,CITY OF SPRINGFIELD
Department of Planning and Dev~ment
I Building Safety Divis~
, 225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPEC~
APPLICATION
SPRINGFIELD
.
DATE: rn~ It.. Iq8~
JOB ADDRESS:....3JSO E ~ 5t ,-~fR,&:ftELLIlf!..
m-1NER: (jRF~ SiAl€' ,f)ff1. ()f' +(J~:def
mmERS ADDRESS:~J5{) E MAIN ~:{.. SfR'N61i~LIJ ill!...-.
APPLICANT:~ sfA1~ ~ tJr .{I<::I/ 4NiJ li},Lt)Ltrr
APPLICANTS ADDRESS: 3/...~(j ~ MAu1 sf S/?EjNt~1;a.L"
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: 72.1.-:l.48E
~~w~ 6'r &......;e.JZ..~..
'--"JROPOSED USE:Eas.I"~<:.<:' I'lFYCFS; .fkpf At" hJHlbJ,l!Jli r~
A $ 35.00 INSPECTION FEE IS REQUIRED AT THE TIME *
OF APPLICATION ' .
THIS APPLICATION FORM MUST BE SIGNED BY THE OlmER OF THE PROPERTY TO '
BE INSPECTED.
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. \..:3GNATURE 'OF PROPERTY mmER-
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
RECEIPT NUMBER:
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DATE PAID: A=,.....!"".rv~ ~/.c-~
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STATE FORESTRY DEPARTMENT
BUilDING NO. 67- 003
RESIDENCE NO.2 AT SPRINGFIELD
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