HomeMy WebLinkAboutSpecial Inspection Application 1995-3-21
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COURTESY INSPECTION APPLICATION
(RENTER REQUEST) \ID3~3 \ OlJJ(d::f)
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE: '-f()<AAo.h ~') )Cfq.s- 'JOB NUMBER:
ADDRESS OF INSPECTION: flU ( nl~AI "Lrt: ,wd (}62..e Y.9"l
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OIJNER: ~f\ '11) /">JlU VI) PHONE NUMBER: '0l/~ -tj~44
O\JNER'S ADDRESS:
RENTER: .:/AM.'M Y Ov'b l?'('~rre:f CP..e, 4e~~ONE NUmR'Lt1!,g,l 7d& -I>~/'p
SIGNATURE OF OCCUPANT (RENTER): ~)/W7VVJ{ (6. fL.U-t f) ,
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: hL/-0d/...l).J *
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TYPE OF DIlELLING: SINGLE FAMILY I I DUPLEX I I MULTIPLE I~ ' ,
.'BRIEF DESCRIPTION OF MAJOR PROBLEMS: 91 p ~ ~ ~/, 3 :d()-15
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FOR OFFICE USE ONLY
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DATE OF INSPECTION:
COURTESY LETTER SENT:
NOTICE AND ORDER ISSUED TO OIlNER:
DATE FOR COMPLIANCE:
COMPLIANCE OBTAINED - DATE:
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YOU WILL BE CALLED TO SCHEDULE AN INSPECTION
WITHIN 5 WORKING DAYS