HomeMy WebLinkAboutOccupancy Application 1990-5-21
CITY OF SPRINGFIELO
Department of Planning and Dev.pment
Building Safety Divis ,
225 N~rth 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
DATE: 6 - :;)tJ -q,()
JOB ADDRESS: t., SD \Y\~A J fYJlirJ1:./7-0,g -~ V -3) 7'1- rJ/'?oo
OWNER: fO ~ ~cuol-e. ~r-ltell\Ge' M' ,
mvNERS ADDRESS: \l C;o YY'\ ~ ~
APPLICANT:~+M~ G. .~. ~A-(ab V
APPLICANTS ADDRESS: .68~ '3Sd-V\1) P\()(\Ip _ ('4~- lllo1)
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:1-~t :l~A~
PROPOSED USE:
~(lU,,{.e-
A $ 35.00 INSPECTION FEE IS REQUIRED, AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THEOv ~ OF THE PROPERTY TO
BE INSPECTED.
.u\ { J,z~-
SI NATUPi\ OF PR~PERTY OWNER
FOR OFFICE USE ONLY
DATE OF INSPECTION:
/8, ~q . C{o RECEIPT NUMBER: /7/J5v
DATE PAID: 6-)-/- CJo
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: