HomeMy WebLinkAboutOccupancy Application 1986-3-21 (2)
CITY OF SPRINGFIELD.
Department of Planning and Deve ent
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPECT~Y'.n~
APPLICATION ~\,\U"'Cf3l
SPRINGFIELD
DATE: .J - ~ /- yt
JOB ADDRESS: ' .33..20 ~~. ~/.1
OWNER: j~ ~ JJI~ :}/e;-r) t
mVNERS ADD'RESS: ;3 ~ 2..3 /:7." /> -' ~- YCJ'0'/,q ~ MtP-/{.~h/
APPLICANT: /i1!~_1-~J
APPLICANTS ADDRESS: 111/ fef tUe! /;J;;J~4
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PROPOSED USE:
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TELEPHONE NUMBER:
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FOR ACCESS TO PROPERTY--PLEASE INCLUDE
717 - 377..-G. -
A $30.00 INSPECTION FEE IS REQUIRED, AT THE TIME
OF APPLICATION
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PROPERTY ~...
THIS APPLICATION FORM MUST BE SIGNED BY THE OlmER OF THE
BE INSPECTED.
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SIGNATURE OF PROPERTY OWNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
RECEIPT NUMBER: /2.?,/.. / ~4-
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DATE PAID: ~/.2//~r-
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