HomeMy WebLinkAboutOccupancy Application 1985-4-15
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CITY OF SPRINGFIE"'l ,
Department of Public~rks
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
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JOB ADDRESS: 3;t1..1 h~,~ S+
OWNER: Ma I'u. hjn " + S Cf'\ ^
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mVNERS ADDRESS: ,-1,~.J.~. tn ~ ,Q., /
APPLICANT: {)" VI t1 'r ct r4crt? f VII; "I/L
qAPPLICANTS ADDRESS: 38<;:1, 6q {/2.. ().plL-Crt'
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OCCUPANCY INSPECTION
APPLICATION
DATE:
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FOR ACC~ PROPERTY--PLE~E INCLUDE TELEPHONE NUMBER:
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PROPOSED USE: Clrl1-0 {)r;\e.( F!pl'.(..r-cG
A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION
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THIS APPLICATION FDRM MUST BE SIGNED BY THE OllliER OF THE PRDPERTY TO
BE INSPECTED.
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PROPERTY OIVNER
FOR OFFICE USE ONLY !
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DATE PAID: L/ /; r- /;r r'
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: