HomeMy WebLinkAboutOccupancy Application 1990-9-6
CITY OF SPRINGFIELD
Department of Planning and Deve~ment
Building Safety Divi.si.W
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
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OCCUPANCY INSPEC~_
APPLICATION
SPRINGFIELD
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JOB ADDRESS: \\G\n .N"'\o., f'\
OWNER: ,-~~ ~;e~r
DATE:
O\VNERS ADDRESS: //9/1 /7'JA/n.... .
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APPLICANTS ADDRESS: ~l.\4 <; \ I
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INCLUDE TELEPHONE NUMBER: l 4. I S(() V
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APPLICANT:
FOR ACCESS TO PROPERTY--PLEASE
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 OlTNER OF THE PROPERTY TO
BE INSPECTED.
S~~OWNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
RECEIPT NUMBER: 1'8 )./Lf
DATE PAID: c:; I "'/C,f,
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
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