HomeMy WebLinkAboutOccupancy Application 1984-12-5 (2)
CITY OF SPRI NGFI ELlrl:.i1i"
Department of Public KS'
Building Safety Divi on
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
- CeuPANCY INSP
APPLICATION
DATE: ~_ <I'1r;/
JOB ADDRES S : c~.;I 5/ (l;1ltrtJ,
OWNER: V (k,i:::::t<. f2>A~h fJOVTY
mmERS ADDRESS: )/'!5 .14J9f?r:s
APPLICANT: fU /.:rr?_ / L 1/I1) F 1'1('/ H
APPLICANTS ADDRESS: p/J) 2, ())( I ,:/ ~ <;? to I !J 6 ~ I r-: 1- j) (j"'j2 .,'.
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: 7C(&;7 b 7 f
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PROPOSED USE: '1V1 E--i\,- (' i I 'IT I JJ Co '7 . r A i.-E .s
A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION .
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THIS APPLICATION FORM MUST BE SIGNED BY THE o~mER OF THE PROPERTY TO
BE INSPECTED.
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SIGNATURE of PROPERTY O1mER/ ./
FOR OFFICE USE ONLY
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DATE OF REPORT: . DATE PAID: I.J r/ k- </ .
DATE OF CERTIFICATE OF COMPLIANCE:
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CITY OF SPRINGFIEL_D(tJiift'
Department of Public I(~' '_,
Building Safety Divi n
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
DATE:~_ <rt{ry
JOB ADDRESS: c2 d 5/ ~1 PrrN ,
OWNER: V f+<.. C K riAR.?, fi ()UTY
OIVNERS ADDRESS: Y{!5 ,1 M;J9P'(z"
APPLICANT: It,; /1rZ- I L 1/ A) F I Tt H
APPLICANTS ADDRESS: P/l )2,0)( 1.1? <;? /2 l,vb;:: I C 1_1lf'3-j2.... '.
FOR ACCESS TO PROPERTYupLEASE INCLUDE TELEPHONE NUMBER: 7C((, 7 b 7 f
'.
',,'
PROPOSED USE: fV1 Ef\i (' i/'IT f JJ c, c; .r A L-E .s
A $30.00 INSPECTION FEE IS REQUIRED. AT THE TIME
OF APPLICATION '.
THIS APPLICATION FORM MUST BE SIGNED BY THE OvmER OF THE PROPERTY TO
BE INSPECTED.
'/)J!h~~L:~'1 ('-LV: h:-./<-rY-'
SIGNATURE of PROPERTY OIVNER I ./
FOR OFFICE USE ONLY
:~~:-::~::::::~:::~\~~-~~~'\--~~:~:~~~~-~-;-~~~--~----~~.
DATE,.oF REPORT: \ '. 60 DATE PAID: I.) J 1")~ </
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DATE OF CERTIFICATE OF COMPLIANCE:
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