HomeMy WebLinkAboutOccupancy Application 1986-5-27 (2)
CITY OF SPRINGFIELD
Department of Planning and Dev~ment
Building Safety Divis~
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)'
OCCUPANCY INSPE~N
APPLIC~)
DATE: f) /2.7 /r-6
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JOB ADDRESS: :3J>3/ dlo..l....#./ ~-I-
OWNER:,X" r-::.,. 13 (),..o/).ilv-i..,.,s
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OHNERS ADDRESS)< cj" ..lIS- r;. /3-(1..,4...,~ 1E~4e~e bit q7lfDI
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APPLICANT: CoI1lf'I/!/I'tJII/JlJI/; Inti I cbil,' c... R lilfJ$l)N5 Dllffl,; r~e4 pI/it).
APPLICANTS ADDRESS: '2.>1131 11l,;t;,v 5<f. C;.o-f)"f C1?'I7?
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FOR ACCESS TO PROPERTY - - PLEASE INCLUDE TELEPHONE NUMBER: 77'? -2307
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PROPOSED USE: _tlehr ,'NI1 ry C.).i.JJLic .e^lfM.t!/~ /tJA/
A $ 35.00 INSPECTION FEE IS REQUIRED. AT THE TIME
OF APPLICATION
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THE PROPERTY TO
THIS APPLICATION FORM MUST BE SIGNED BY THE OvlliER OF
BE INSPECTED.
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/~RE OF PROPERTY OIVNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
RECEIPT NUMBER: t3 0 & r.;~~
DATE PAID: 5-.;l. 7- f(:,
COMMENTS: