HomeMy WebLinkAboutOccupancy Application 1984-7-20
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CITY OF SPRINGFIELD'-',
Department of Public l4~s
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPEC~N
APPLICATION
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JOB ADDRES S : Otf)..'D fYJa. itv'
OWNER: .L..;I/~It/ A- ,v'16~O\C\S
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mVNERS ADDRESS:
APPLICANT:
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APPLICANTS ADDRESS:
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FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: /lVoJV~.
0'61 ~;)7S" I~Fh/?.. 7/,""7 J.8b-tJ6/7 " (YIe5Sq~ c::
PROPOSED USE: '6::tV'-q.,u<:'.T ;1";_ Halj
A $30.00 INSPECTION FEE IS REQUIRED. AT THE TIME
OF APPLICATION -
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THIS APPLICATION FORM MUST BE SIGNED BY THE OrlliER OF THE PROPERTY TO
BE INSPECTED.
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SIGNATUP~ OF PROPERTY OIVNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
RECEIPT NUMBER: 73'63'2 S(!;
DATE PAID: 7--;;;?o-8 Y/ -::::?:-;2::::>.
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