HomeMy WebLinkAboutOccupancy Application 1996-11-5
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FAX (541) 726.3689
OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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ADDRESS OF INSPECTION: 35';(';;' 7Jl..u.,::J
170;1313/ O~(X)Q
Ol/NER: (} ~~ r\'''' "" ~. \L, "'.LVl PHONE NUMBER: '71 I:) -OIC(]
Ol/NER'S ADDRESS:
APPLICANT: ~":,.( 9'- ~-7J^" ~...-/
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APPLICANT'S ADDRESS: /:2. 90 "'- /..-? ,,'K:~_O-V..,..A....-J 9.7P"0c2
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: I <:lCc. - qq, i; ;_~:~.~
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PROPOSED USE: CX-~fI- 9<-'''' ,........"-4.
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OI/NER OF THE PROPERTY TO BE
INSPECTED. ----
SI~lpROPE~TY Ol/NER
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FOR OFFICE USE ONLY
DATE PAID:
11--5-q0
RECEIPT NUMBER:
.DATE OF REPORT:
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DATE OF INSPECTION:
DATE OF CERTiFICATE OF COMPLIANCE:
COMMENTS:
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PROPOSED FLOOR PLAN REQUIRED AT TIME OF APPLICATION