HomeMy WebLinkAboutOccupancy Application 1986-4-14
CITY OF SPRINGFIELD III
Department of Planning and Deve~ment
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
DATE: ~/-/L( - ~c.
JOB ADDRESS: 3::S O~ M-4i/U
OWNER: ( J- s::., _ r RG ~;I l e,R..P'
OCCUPANCY INSPEC~
APPLICATlO
OIVNERS ADDRESS:
APPLICANT: R t:\ ('. K. Ii'?" ((SIZ ~Ol( /I/lA..JGG MAIV"';/€'
APPLICANTS ADDRESS: '-I (L-I <. DA.) S 1../ <.T-
I
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: 7 '-17- F 'J7 ~
.b4L$" R. ~AItK D UL-L ~ {l< ~hC.( fh; L I ,'1' J'
PROPOSED USE: 0,0.4 T SIiJ.E.~- 'l!I< ~
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A $ 35,00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OlrnER OF THE PROPERTY TO
BE INSPECTED.
~ ~.
~_ ~ /l/,. 7 d.
AT~P~~
FOR OFFICE USE ONLY ~
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DATE OF INSPECTION:
RECEIPT NUMBER: 1S to (p ::z.s 7
'-i-I? -f &;
DATE OF REPORT:
DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: