HomeMy WebLinkAboutOccupancy Application 1990-1-2
CITY OF SPRINGFIELD '
Department of Planning and De~pment
Building Safety Divis~n
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~N
APPLICATION
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1750 111~
OWNER: ?~..... t K (~de.L L
millERS ADDRESS: Y[f~ 2. A-p.pLQ... -Iy~-t.
APPLICANT: .:{/t),.",- L. K' ~4e.Ll
APPLICANTS ADDRESS: 1'10 ( MayJ,..4..:f-
JOB ADDRESS:
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SPRINGFIELD
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DATE:
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FOR ACCESS TO PROPERTY--PLEASE INCLUDE
~7 s(Jl")~/~c.J.
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TELEPHONE NUMBER: 7 2 ~ -6,~ /"
PROPOSED USE :~~. s..\~ 0
A $ 35.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION .
THIS APPLICATION FORM MUST BE SIGNED BY THE OI-1NER OF THE PROPERTY TO
BE INSPECTED.
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SIGNATURE OF PROPERTY O\~ER
FOR OFFICE USE ONLY
DATE OF INSPECTION:
RECEIPT NUMBER: I Z:SCo04
DATE PAID: J -cJ -qc)
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: