HomeMy WebLinkAboutOccupancy Application 1988-1-6
CITY OF SPRINGFIE,-
Department of Planning and , ment
Building Safety Divis
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INS~
APPLICATION
SPRINGFIELD
DATE: J _ (., - 8- ;g- " ,1 :::/:F f? 0 () / I
JOB ADDRESS: ::J..f). ) / / '-n1 ().. ..:::... /'"0- ~ t..........I
OWNER: ... I At'r,}- 9-,,1} rl} U.[.J/Ld__HYL. ~
mVNERS ADD~SS: '(f.. R c-7 '3 7'Y\ ~ ..A.5Jr '11"
APPLICANT: <7nc //~.J.A c.,.p~ <;-'0 If"' J)h"'w/Jy1leJ)..[; iPcf:t~~
APPLICANTS ADDRESS: ;:2:1.) <; 1?7.A; ..r
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:
7 ::2,t. -- 7 '7 'd-L
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PROPOSED USE: f)" y- (. \.t)...u--.J)~ ,4 '\f'r'1V e -i: S L -e.. -e l--
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A $ 35.00 INSPECTION FEE IS REQUIRED, AT THE TIME
OF APPLICATION .
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THIS APPLICATION FORM MUST BE SIGNED BY THE OlmER OF THE PROPERTY TO
BE INSPECTED.
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It;O /;IGNATURE OF PROPERTY OIVNER
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FOR OFFIC USE ONLY
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
RECEIPT NUMBER:
DATE PAID:
COMMENTS: