HomeMy WebLinkAboutOccupancy Application 1994-10-3
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE: /0- 0:3 - ;:3' Y JOB NUMBER: qLf~C)z.x--.-
ADDRESS '01' INSPECTION: #/> #4-,' 17 5;Lr / 5;:;,'rl9ke. \ l O~.q~l./17
OYNER: ~('>~f ~,0:Jl.((.,.c~/),'i)5i/ PHONE NUMBER: (; 'lY-700J
OIINER'S ADDRESS: '7;:) L. 7<;))
APPLICANT: ~)05k... 01., J.1 () rR -(II () .114 r,'C. ~ ~ c1(<-C" "
APPLICANT'S ADDRESS:. Z;,;Jc: .$, s c,':-+ ~ 5J-~', -5/rl ~r;'r,'~ I d. lJR. 97V7}
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: ?9"'?~6/f1 ()r 7~ ,~- />/1j
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PROPOSED USE: \..tI..\J.e. 6. ~o'fUc;.,l/ tA.,.,d Cv/B~ tfJa./1 ~61.J,./d 1'~5/J-R-
/5d; II nc; --\.G )..;, \J:.. ~.Q -\..\.....Q J...D01{1 Q 'rOD~ .
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OYNER OF THE PROPERTY TO BE*
INSPECTED.
CLv. -t.-.i ~.
SIGNATURE OF lROPERTY OIlNER .
FOR OFFICE USE ONLY
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RECEIPT NUMBER:
I tf{31
DATE PAID:
DATE OF INSPECTION:
DATE OF CERTIFICATE OF COMPLIANCE:
DATE OF REPORT:
COMMENTS: