HomeMy WebLinkAboutOccupancy Application 1994-2-24
1-
.
:rl0 'iO~3:J
n O~.3151 'D Ie, (.,0 I
OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
================================================================================
DATE:
February 23, 1994
JOB NUMBER: q/...{O? 3-:;;
ADDRESS OF INSPECTION:
3445 Main Street, Springfield, OR
O\lNER: S:f. j)v"'.J CIIJ/1/IlFAlS /.(fJ-rr'
O\lNER'S ADDRESS: 9g? -S"ltUmtWJ /JL I'f//-.. !'?J1!'
PHONE NUMBER: ~r~-~~
(N nw/
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER:
503-726-8453
,~
~T
APPLICANT:A Street Automotive Specialists, Inc.
APPLICANT'S ADDRESS: 1720 South A Street , Springfield, OR
================================================================================
PROPOSED USE: Automotive Repair and collision
A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE O\INER OF THE PROPERTY TO BE
INSPECTED. -
/LPflL6,/. ~y~
~ATURE D~~ERTY OWNER
--------------------------------------------------------------------------------
FOR OFFICE USE ONLY
--------------------------------------------------------------------------------
DATE PAID:
.;lbqla'-f
RECEIPT NUMBER:
117SCJ
Q5
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: