HomeMy WebLinkAboutOccupancy Application 1990-11-26
CITY OF SPRINGFIELD
Department of Planning and Dev~ent
Building Safety Divis~
225 North 5th Street
Springfield, Oregon 97477 ..
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~
APPLICATION
SPRINGFIELD
DATE: // -2(p - 96
JOB ADDRESS: / t) 77
OWNER: YR'l;~F/~uJ
OIVNERS ADDRESS: 2!;0
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APPLICANT:
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APPLICANTS ADDRESS:
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: ~~~ ~~~
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PROPOSED USE: /t#,6/.:/~/t/t: 7If/J/~/;V(. U~/~H/~~~/~t.f: ..
A $ 35.00 INSPECTION FEE IS REQUIRED. AT THE TIME
OF APPLICATION .
THIS APPLICATION FORM MUST BE SIGNED BY THE OvillER OF THE PROPERTY TO
BE INSPECTED.
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SIGNATURE OF PROPERrl owNER .
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
RECEIPT NUMBER: /&,,8/"2.-
DATE PAID: //-7&-90