HomeMy WebLinkAboutOccupancy Application 1983-9-6
CITY OF SPRINGFIEL~
t~partment of Publ ic l~s
uilding Safety Division
225 North 5th Street
S ringfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~ON
APPLICATION
SPRINGFIELD
F3?f}JY) P,
DATE:~(E'P'T. 6 l'lf3
JOB ADDRESS: '072 MMN Yr.
OWNER: SPI'-./NGFln.o OIvRCJ.j 010 1'1-1': BRET/fR6'N
mmERS ADDRESS: 10 't2 MI'r-/lJ >1. (PAloR 1l-l)~~0l': "160 /II. 2./(J' 51:)
APPLICANT: ])MG" R. SEEse
APPLICANTS ADDRESS: '2..4-1 'vI... /( ,. Sr. JPF...'P
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: J),4Lf )m~ REf1()[)/c07lf7.'fm,
J>>B fl'rf: PI/;IN\f 72.~ -i-i25- , ,_.
~owiJ s'rftl.lI.f! CI{l/rt'-"l Ib'"seMBw Pc~ I(~ pEYUotolJ
PROPOSED USE: VPS'N\1fl~' OFF. c~J
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A $30.00 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 PROPERTY OWNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:C\-~-R3
\\'I))~RECEIPT NUMBER: lo!ftJ4 ~
DATE PAID: !"\2.fu. Lo,~ ;?//I
\ '
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
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