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HomeMy WebLinkAboutOccupancy Application 1995-10-31 " ..... , . . \ OCCUPANCY INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING DIVISION c=c============================================================================= 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: ~ ,A( ================================================================================ , PROPOSED USE: _L \A.Br, niL II- f\l,fq r.~~s I 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. K.~~,~,C4yA~d~~~ SIGNATURE OF PROPERTY Ol/NER ' -------------------------------------------------------------------------------- FOR OFFICE USE ONLY -------------------------------------------------------------------------------- DATE PAID: lI-q-qt5' RECEIPT NUMBER: /q5tf ~/ DATE OF INSPECTION: DATE OF CERTIFICATE OF COMPLIANCE: COMMENTS: DATE OF REPORT: . .... ,. "- .... ,. !':"'::.:.-,:....