HomeMy WebLinkAboutOccupancy Application 1990-1-9
CITY OF SPRINGFIELD
Department of Planning and Deve.- ent
Building Safety Divisi
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPEC~
APPLICATION
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DATE: /'9/90
JOB ADDRESS: J J 2c Jt,., ........--:... lJ-.-..
OWNER:
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mVNERS ADDRESS,: 5' S- SL4~r 1_"....,t'J
APPLICANT: ~~
APPLICANTS ADDRESS: ,~
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:
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PROPOSED USE: -h. L };.'''-o lKlJJ .
it: $ 35.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION
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THIS APPLICATION FORM MUST BE SIGNED BY THE ,OvlliER OF THE PROPERTY TO
BE INSPECTED,
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SIGNATURE 6FlPROPERTY OWNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION: ,. \ \ ..y \ . \4 .q I RECEIPT NUMBER: / q()4 '7
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DATE OF REPORT:
DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
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