HomeMy WebLinkAboutOccupancy Application 1996-7-5
rl
. .
"SP"..FIELO"
",
DCVC/.OI'MCNr:;uIl'lCCS fJC!WIIMI.Nr
/f1tN: ,4~1 0;/ld+
OCCUPANCY INSPECTION APPLICATION
;'25 FI/ 7/1 smu./
SfJFUNGF/CLD,01197471
(541) 726,3753
FAX (541) 726.3689
CITY OF SPRINGFIELD
BUILDING DIVISION
c============::=================================~====================7j=========
DATE: 7 - ..7 - 7 { JOB NUMBER: "\l.oOC\ \
ADDRESS OF INSPECTION: 3lFO A Q,f "v'L .51. 5/11 \ ~ -
O\/NER: JivI r; re.o. r/ Art MI/J PHONE NUMBER:/-J(tJ,6'lj-7332
X OwNBR' S ,\DDI\ESS:
APPLICANT: r;.,.,cf Prvx/J,"~
APPLICANT'S ADDRESS: ~'JI 71.IAr(-!Co-h Rei 11= 7
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: ?q-u- - 2311:4::- (\A-LL-
c=c===============================================================~Q=====C======
PROPOSED USE: ~fPfeOt? O""-tlt2.. Tl. i'U + Po 1'Ie4'1/
V
"
A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE
INSPf~TfD. -
X \ .9M1~,clL~_
SIGNATURE OF YKUY~KTI UwN~R
--------------------------------------------------------------------------------
FOR OFFICE USE ONLY
;:;;-;;;;:----"\:<i::i:lll:~------------;-;.,-;;;;-::::-..-:---~~~"I~-----
DATE OF INSPECTION: DATE OF REPORT: ..
DATE OF CERT1FICATE OF COMPLIANCE:
COMMENTS:
''','
PROPOSED FLOOR PLAN REQUIRED AT TIME OF AP-PLICATION