HomeMy WebLinkAboutOccupancy Application 1996-4-8
~
~ '11n'I~
@ttI (E);J~"~.JFfL=J~~J;L::J,,e;"~l,,'I) "
, ,/."
:'I.'~I'IIIU" ."_
L~'
t~~~~, t.:.,,, !
--~~"""1
" ", '. .
j "
CITY OF SPRINGFIELD
BUILDING DIVISION
lJl-VI:t OJ'MEN/ :;/ J/VJCI S OFI'Jl/I1^'1 NI
OCCUPANCY INSPR~rION APPLICATION
::::::-:-:::ff~~;~-~~~~----~~-::;~::::-9U;t~1
OIlNER: _~&I~ CLfD~/ :f~Z
OIlNER'S ADDRESS: ~~ F /,$2!L bt'c.
PIlONE NUMBER:
3~ -:73cfl
-f-[!, S- -Dr' 2..b
APPLICANT: -rzilJOI.J'J.A/jJJ,.1 _ I",u~~ (I.J<- ,&"J7R~ _
~ ,) .' ?,~(.,
APPLICANT'S ADDRESS: /7/"1 /11!J.t...J -sr. sl.e~,((U) <i'n Q ,
FOR ACCESS TO PROPERTY - TELEPHONE NUI1BER: _'1u, -3f3(]>(RJ!:~), n.e , W~-~66@ev
aQaQ~aDA~Agg=_g==~~_~~~~_~;=;=;=~=~=======~========Q==aQ==m===A====aa====a=~a===
PROPOSED USE:
~,f) ~.rl7l.JS~)
"
"
A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY TilE OIlNER OF TilE PROPERTY TO BE
INS~ -
~~::::~::~:_~-------------------------------------------------
fOR OFfICE USE QNLY
DATE PAID:
4/~~?'
RECEIPT NUMBER:
2/0/)7 ..<~~
DATE OF INSPECTION:
DATE OF CERT!FICATE OF COMPLIANCE:
,DATE OF REPORT:
COMMENTS:
", ,..:".M ~~ );;'t'"l:~"