HomeMy WebLinkAboutOccupancy Application 1990-7-5
CITY OF SPRINGFIELO
Oepartment of Planning and Dev~ment
Building Safety Divis.~
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~N
APPLICATION
DATE: Julv 5. 1990
q()Of(4~
JOB ADDRESS:
OWNER:
3988 Main Street, Springfield, OR 97478
Jim Pesiri
i
mVNERS ADDRESS:
3988 Main Street, Springfield, OR 97478
APPLICANT:
Teen Challenge of Oreg9n (Lou Mamone)
APPLICANTS ADDRESS: 75 West Morton Street, Lebanon, OR 97355
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: 1~6-9769 (Owner)
Teen Challenge of Oregon - 259-3401
PROPOSED USE:
Second Hand Store
A $ 35.00 INSPECTION FEE IS REQUIRED. AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE .OvrnER OF THE PROPERTY TO
BE INSPECTED.
.~
~
~
,
SIGNATURE OF PROPERTY OWNER
FOR OFFICE USE ONLY
---------------------------------------------------------------------------
DATE OF INSPECTION:
'7. ~,q()
RECEIPT NUMBER: / 7& d -;)-.
7- 5.t10
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
DATE PAID:
COMMENTS: