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HomeMy WebLinkAboutOccupancy Application 1984-12-5 / 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 * ./ '," . - 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. COMMENTS: