HomeMy WebLinkAboutOccupancy Application 1996-3-27
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OCCUPANCY INSPECTION APPLICATION
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FAX (541) 726.3689
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DEVELOPMeNT SUlVICLS DEI'''lll AlUI r
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE: _~~~ "2.?-_L/''7'6 JOB NUHBER:
ADDRESS OF INSPECTION:?>lV2 .M;9#/ ~~
Ol/NER: vlfJYf'iF':5 ,~E ~"f/ PHONE NUMBER:
Ol/NER'S ADDRESS:~~/;;2 /'Y7;?-~ ~-r <-
APPLICANT: {~~/~~~75/ ~~.-
APPLICANT'S ADDRESS: '7'5';/";> -:5~L'--G <~2.$:-
FOR ACCESS TO PROPERTY - TELEPHONE NU'1BER: _'2tL.~ -/'2 :YC
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PROPOSED USE: ~T 2r >~7~.J ?h ~/c-? ~
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A $35,00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE Ol/NER OF THE PROPE
INSPECTED.
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FOR OFFICE USE ONLY
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DATE PAID: 7,2,/-%
RECEIPT NUMBER I :;?&>g '/'2..
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DATE OF INSPECTION:
DATE OF CERT1FICATE OF COMPLIANCE:
COMMENTS:
,DATE OF REPORT:
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