HomeMy WebLinkAboutOccupancy Application 1978-12-18
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. OCCUPANCY INSPECTION APPLICATIt
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CITY OF SPRINGFIELD BUI WING DEPARHIENT ~
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JOB ADDRESS: ...2/ 03 W~ NUMBER OF UNITS: /
OWNER:,r:{J~;~ 77%n.rP5',J ADDRESS: .;2/(j':J ~/A/ U.
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APPLICANT: ;t(/ W4-0/'tr6' Y /66 "'~?"F'--'ADDRESS: fl/6' ..J b f"J Y?"'L,
72- G /?2S-
EXISTING BUILDINGS
FOR ACCESS TO PROPERTY - TELEPHONE:
A $20.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS, APPLICATION FORI.1 ~IUST BE SIGNED BY THE OWNER OF TilE PROEPTY TO BE INSPECTED
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.-SIGNATURE OF' PROPERTY"'OWNER
FOR OFFICE USE ONLY
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Date of Inspection: 1.2-/t?- 7 r
Date of Cert, of Compliance:
Date of Report:
Receipt Number:
REMARKS: