HomeMy WebLinkAboutOccupancy Application 1988-3-25
CITY OF SPRINGFIELD
Department of Planning and Dev~pment
Building Safety Divis.'.
225 North 5th Street
Springfield, Oregon 97477 .
726-3753 (Bus.) 726-3769 (In'sp.)
OCCUPANCY INSPE~N
APPLICATION
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DATE: 3 r,:? 0- 5?cg-
JOB ADDRESS: ,<:;) 19 / I ~ ~_ ~
OWNER: (b~~ ~~ ~.A P~N'~.
OlVNERS ~RESS: L (iif 9' ~ ~'7l /'A1'._ ~
APPLICANT:a~~'- /ltr.e4-Ud ~& /H4:;///,~:"'.<
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APPLICANTS ADDRESS: 22 // ~4/d
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FOR ACCESS TO PROPERTY--PLEASE
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INCLUDE TELEPHONE NUMBER:
q~ \ 'S~06
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PROPOSED USE:
A $
35.00 INSPECTION FEE IS REQUIRED AT
c?~\
THE TIME
OF APPLICATION
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THIS APPLICATION FORM MUST BE SIGNED BY THE mINER OF THE PROPERTY TO,
BE INSPECTED.
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~;6'N"AiUFm OF PROPERTY Ol.mER
FOR OFF USE ONLY
----------------------------- ---------------------------------------------
DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
RECEIPT NUMBER: Ill9'q
DATE PAID: 3-~s -x-K'"