HomeMy WebLinkAboutOccupancy Application 1995-6-12
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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ADDRESS OF INSPECTION:
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JOB NUMBER: _ q~{) 93r
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DATE: r:.. //1 I 9 S
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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:
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APPLICANT'S ADDRESS: AH/vlt5.4 (' 4,PuJuC:
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: d k-"; - ..I 0 '7 /
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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.
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~GNATURE OF PROPERT~VNER
FOR OFFICE USE ONLY
DATE PAID:
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RECEIPT NUMBER:
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DATE OF INSPECTION:
.....DATE OF CERTiFICATE OF COMPLIANCE:
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COMMENTS:
DATE OF REPORT:
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