HomeMy WebLinkAboutOccupancy Application 1995-10-31
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE: ID"'~ 1- qc;
ADDRESS OF INSPECTION: i2;3()~
JOB NUMBER: qSJ 77 I
mA;t-) 31 ~WU) oe Q1yn'
OIlNER: 3tE>JE MASkAL
Ol/NER'S ADDRESS: gjloq 0. ()lh SI,
PHONE NUMBER:
S~~D OR.
"APPLICANT:
x: APPLICANT'S ADDRESS:
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER:
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, PROPOSED USE: _L \A.Br, niL II- f\l,fq r.~~s
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A $35.00 INSPECTION FEE IS REQUIRED AT THE T~ME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE O\INER OF THE PROPERTY TO BE
INSPECTED.
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SIGNATURE OF PROPERTY Ol/NER '
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FOR OFFICE USE ONLY
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DATE PAID:
lI-q-qt5'
RECEIPT NUMBER:
/q5tf ~/
DATE OF INSPECTION:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
DATE OF REPORT:
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