HomeMy WebLinkAboutOccupancy Application 1985-10-3
'. CITY OF SPRINGFIEL~
~i~epartment of Public ~ks
;.;,;,;~uil ding Safety Oi vi s 1 on
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. ~Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
Ii, OCCUPANCY INSP~ON
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SPRINGFIELD
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~;_: JOB ADDRESS: /'10'0 ,1141,) $....-_ . ,<; PIi' IVc....r=U:LO \ r A;)
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.j}'(;'i.R~~ ACCES,S TO P.ROPE~TY--PLEASE INCLUDE TELEPHONE NUMBER: ?'-I (.
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-',rfPROPOSED USE: IJ. JFU> .AJt:. "'I"ODi..y loA12 lL.It4-ous.F
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:; ':,. A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
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":'-aTHIS APPLICATION FORM MUST BE
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SIGNED BY THE DtlliER OF THE PROPERTY TO
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SIGNATUP~ OF PROPERTY D~VNER
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FOR OFFICE USE ONLY
~ECEIPT NUMBER: ~ ~ 5' 3c:r :3
DATE PAID: tao.DO
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0", DATE OF CERTIFICATE OF COMPLIANCE:
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" COMMENTS:
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CITY OF SPRINGFIELD.
Department of Public W s
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~N
APPLICATION
SPRINGFIELD
DATE: }() /3 / ~ 5--
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JOB ADDRESS: / "10 <0 f1 ,4 'A) Sr-. ,<; PIi' ,,,,) L.. r:: U: co I'h
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OWNER: {:'"L LIA/~ I,; AlTEIZ....?R n.es .ING
OI-lNERS ADDRESS: '-/O'-/St?, mj!J)N <;r..
APPLICANT:- S4~ L
APPLICANTS ADDRESS: - c:::.., '-\.... <-
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: '1'1 ~ f-.J0 '7:3
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PROPOSED USE: II. }i}:rLb lilt- <<"DOL:..,..
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THIS APPLICATION FORM MUST BE SIGNED BY THE OvrnER OF THE PROPERTY TO
BE INSPECTED.
A $30.00 INSPECTION FEE IS REQUIRED. AT THE TIME
OF APPLICATION -
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SIGNATURE OF PROPERTY OHNER
FOR OFFICE USE ONLY
---------------------------------------------------------------------------
DATE OF INSPECTION:
RECEIPT NUMBER:
DATE OF REPORT:
DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: