HomeMy WebLinkAboutOccupancy Application 1995-3-8
....
lIl, SENDER:
~ . Completll items 1 end/or 2 tor additlonalservic8S.
. CD . Complete items 3, and 48 &. b.
f! .- Print your name and address on the reverse of this form so that w an
CD return this card to you. . .
~ . Attach this form to the front of the m8ilpiece~ or on the backllf spece
.. dOllS nOl permit. . ~ ~f
'.! . Write "Retum Receipt Requested" on the rnal1piece b8t.Q....ure~atticI8 number 2 0 Restricted Delivery
... . The RetlJrn Receipt will show to whom the article wes d'l1~ cf'Bnd the date .
I 6 delivered. ,. 0 . Consult postmaster for fee.
, i 3. Article Addressed to: 40. bST~N-7mb3 3lf LID I
a. KO:50\'V'O.1'\j G e. W 1- 4b. Service Type
.! q 0 '2- 9 q f\.t 1, Vi uU ~ ~:~~::~ed ~ ~~~ed
-.J ffixpress Mall 0 Return Receipt for
,j L.ec.tblAvq ,OK Q7L{'t'1 7.00teofoel;Very Merchendi.e
~ , \ 3- 5S -qc::::' 5
-- .. >-
~ 5. Signature IAdarisseel ~ 8. Addressee's Address (Only il requested ~
::I rn and fee is paid) g
t- ! /1j'<>e""'" ~ .r.
I ~ 6. Sigrlature (Agent) \ ~
:;
o
,. PS Form 3811. Oecember 1991 ~U.S.GPO"003-3S2.71' DOMESTIC RETURN
.!!!
I also" wish to receive' ~
following services (for an. ,;
'eel: ~
1. 0 Addressee's Address ~
li.
a;
U
III
.c
E
"
;;
a:
Ol
,e
"
"
~
o
~
Ra>-r
Official Business
.
I II II I
--
_.r_
4 _. ....-' - .____~.__
. PENALlY FORPAIVATE
. USE TO AVOID PAYMENT-
OF POSTAGE. $300'-
~"
-
I
I
I
I
I
I
I
I
I
I
I
I
I
Print your name, address and ZIP Code here
. .
DEVELOPMENT SERVICES
225 FIFTH STREET
SPRINGFIELD, OR 97477
.
.
1703~L/Z -(t)(p0f)
OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
=====================~================================.,=====================
DATE: ? fGi0 q') JOB NUl-mER: qSo IS 7
ADDRESS OF INSPECTION: I~ cf() 'ii A "'-CAS.S} ~i.I,,^~Q;0l.d C'P----
\l "-n-'
O\lNER: ~Ka5LvY\ UV J-~?' >~e- v+- PHONE NUNBER: g~ f., - 7) 3'13
O\lNER'S ADDRESS: 0.0 1-,0.3---.b..L+, V u.c..;J L h, ltc<J';J(M,"0_{)\fL - a,..... J.tr/
APPLICANT: ~ 1r:.>tl.U~( De.Sl '~r-- ~.e..o,/o...'A.Ji.:J'!S .
APPl.ICANT'S ADDRESS: L'l....Vo &lG\..L.....-5\-- SpYVCj-he lJ O'<L.c;,\{u
FOR ACCESS TO PROPERTY - TELEPHONE NUNBER: C/<-f:l- O,J to -/- C7 to - Z.00/1.!'~)
::;::: == === ===== ===== =======""'::; ===:;::::::.-=:;::;::;:=:= =====~============;::=' ;.' ======::: ~:;:,::?>-: :::;;.:::,::.;!==:::::::
P!WPOSED USE: _C~.Jf..iLVl,~J' Sl"\..oo
'\
A $35.00 INSPECTION FEE IS REQUIRED AT THE TII.\E OF APPLICATION
THIS APPLICATION FORI.\ NUST BE SIGNED BY TilE O\lNER OF TilE PROPERTY TO BE
INSPECTED.
c? ~~_ 91:, / , 1-
SIGNATURE OF PROVERT~-
FOR OFFICE USE ONLY
::~:-::::~~-~~--c=r-~----------::::::~-::::::~--~;;~~~~-~------
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF CONPLIANCE:
COHHENTS:
,
-it