HomeMy WebLinkAboutOccupancy Application 1994-11-17
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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PHONE NUMBER: Zi.7-1../ Sf:--
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APPLICANT: . Vlr.VI!) WI/-/...(1<;1>15 --r--
APPLICANT'S ADDRESS: 87b N.W, {p1:b. ST. dnlo-tfS 'f/J65 ~q7sz.(,
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: ~~ ~/71- "I':::" W~N>' ~CC.J
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PROPOSED USE: P~"l 5'ulfW S~ "1OBI<~D ffU>pu,.r~ ~~ (<>
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THIS APPLICATION FORM MUST BE SIGNED BY THE O\JNER OF THE PROPERTY TO BE "0 Ii"'"
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FOR OFFICE USE ONLY ~t '[
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JOB NUMBER:
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DATE:
ADDRESS OF INSPECTION:
OVNER:
OVNER'S ADDRESS:
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A $35.00 INSPECTION FEE IS REQUIRED AT TIlE TIME OF APPLICATION
DATE PAID:
1I -/7 -'1<1
RECEIPT NUMBER:
(C75/ J
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: