HomeMy WebLinkAboutOccupancy Application 1997-6-26
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(541)726.3753
FAX (541) 726.3689
OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD I '70 3'15i-'! I 07.2Oz)BUILDING DIVISION
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ADDRESS OF INSPECTION: \ I L\ \. m AI f\ \
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OIINER: 1=-D rYl AR I~ (" A(
OIlNER'S ADDRESS: 2-4 (1,1") F" G<<?R-\..!
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APPLICANT: -Eo YY\Aels' C "A (
APPLICANT'S ADDRESS: 2- Cf L (') F ( , Of'1-\} 6 ,4
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PHONE NUMBER: c..PL- Sc:>OS"
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FOR ACCESS TO PROPERTY - TELEPHONE NUMBER:
PROPOSED USE: eel AlII
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OIlNER OF THE PROPERTY TO BE
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SIGNATURE~ OIlNER
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FOR OFFICE USE ONLY
DA~E PAID: (tJ - :2 b -1 7
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RECEIPT NUMBER:
2032$)
DATE OF INSPECTION:
DATE OF CERTtFICATE OF COMPLIANCE:
COMMENTS:
.DATE OF REPORT:
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PROPOSED FLOOR PLAN REQUIRED AT TIME OF APPLiCATION
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