HomeMy WebLinkAboutOccupancy Application 1984-12-5
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CITY OF SPRINGFIEL~ ,
Department of Public \:"s
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~ON
APPLICATION
DATE:k_<7tffY
JOB ADDRESS: dd. 5/ /lII ItrN :
OWNER: Y /1-<, CI< ?;Pd?J, 41 n V T y
OHNERS ADDRESS: S~) 15 ,14~9f?rz.-;
APPLICANT: AA /f112.., L fA) F I TL..-H
APPLICANTS ADDRESS: 'j)/) i:S ())(. I:J. ':{ <; P,Q I AJ b ~ I C L-/) t1{C .
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: 7C(& -7 b 7 f
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PROPOSED USE: .!lIi 6-1\-, (' I j IT, JJ c; '7 J A i.-EJ
A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION .
THIS APPLICATION FORM MUST BE SIGNED BY THE OvffiER OF THE PROPERTY TO
BE INSPECTED.
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