HomeMy WebLinkAboutOccupancy Application 1987-6-8
CITY OF SPRINGFIELD
Department of. Planning and Dev*pment
Building Safety Divis
225 N~rth 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~N
APPLICATION
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DATE, JufH~ C;(, I q ", /~~ ;Jt f{/;(J3q 0
JOB ADDRESS: I 0 '7~ ~O ~n 5--\- ,S gUJkP;L.. \ cD , r) Q <1 '7 c.f 7'-'7
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OWNER: Ckf\J(c-k E>-+- ~ ~(e-tk.{Q...n, 5(Yu'n{YsfeJ J '
OImERS ADDRESS: W72. f'vta,'n stl Sp11J. u(2 C,7Lf77
APPLICANT: ,,\1lY\ ~(f_~~ -C LcM?U\--tJU
APPLICANTS ADDRESS: Codl 36. ~--n....... SO.-Hd, oR. 7/L/T7
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FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:
PROPOSED USE:
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A $ 35.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION .
THIS APPLICATION FORM MUST BE SIGNED BY THE OvrnER OF THE PROPERTY TO
BE INSPECTED.
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SIGNATURE OF PR~~,":P' l'1ur',;,~'
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FOR OFFICE USE ONLY of~~~
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DATE OF INSPECTION: RECEIPT NUMBER: jj ;; rf 1/1 '
DATE OF REPORT: DATE PAID: Ur'/I-f'J
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
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