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HomeMy WebLinkAboutOccupancy Application 1995-6-12 . . OCCUPANCY INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING DIVISION ================================================================================ ADDRESS OF INSPECTION: / 7 ~ q [. , - /Y7 f!I ; .J JOB NUMBER: _ q~{) 93r , C;/,,Q.-~r,' Ei fA I '/)~. DATE: r:.. //1 I 9 S ;. I OIlNER: .....rdr...fifl rcR&u'C::;~~, PHONE NUMBER:?/,h/-/o71 OiINER'S ADDRESS: X 7/ t..l. s:;.-u. /-/L?E-'O<=." j /")R. APPLICANT: -<:;d.It---- /o~ " ~ i!.ol J r? APPLICANT'S ADDRESS: AH/vlt5.4 (' 4,PuJuC: FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: d k-"; - ..I 0 '7 / , ' ~ ~ ================================================================================ PROPOSED USE: n f=: .r ,. t'.E - N A' /~ _CA /~ ~) A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION THIS APPLICATION FORM MUST BE SIGNED BY THE OIlNER OF THE PROPERTY TO BE INSPECTED. ~~ :=t~ ~GNATURE OF PROPERT~VNER FOR OFFICE USE ONLY DATE PAID: 1). vUilt2- 0'b' RECEIPT NUMBER: I f]uqf6 DATE OF INSPECTION: .....DATE OF CERTiFICATE OF COMPLIANCE: -:"' COMMENTS: DATE OF REPORT: ,,".~ -.., "1"