HomeMy WebLinkAboutSpecial Inspection Application 1996-5-29
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COURTESY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
(RENTER REQUEST)
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DATE: ml\l1/ ;)q, Iqq(Q . '. JOB NUMBER: 31am~7/
ADDRESS OF IJ!,PECTION: \ \ S'L fYlo,,\A S-h-e.-e~,t ~rtf\~f\~\cl,l)K_Cf1-lrFf
OWNER: 8'DW P<:i2-D Y 1A.. PHONE NUMBER: ~O 3) 1-4(,:~ 2./
OIlNER'S ADDRESS: l L 52- M M t-J .s,+e~ .
RENTER: tJAn~-tD9~(1r V::.. \ \CJ.- ~ ~{eo\5A\ L-e.~J~N~\UMBER: ~M)LK4 -ql.(rZ- .
SIGNATURE OF OCCUPANT (RENTER): ~Jb-L;~ /' vfiI.(d/u'I11~~1'1O
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER:
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TYPE OF DWELLING: SINGLE FAMILY I I DUPLEX I I MULTIPLE I I
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DATE OF INSPECTION:
COURTESY LETTER SENT:
NOTICE AND ORDER ISSUED TO OYN~~:
DATE FOR COMPLIANCE:
COMPLIANCE OBTAINED - DATE:
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YOU WILL BE CALLED TO SCHEDULE AN INSPECTION
WITHIN 5 WORKING DAYS