HomeMy WebLinkAboutOccupancy Application 1984-4-23
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CITY OF SPRINGFIELD. '
Department of Public W _KS
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726~3769 (Insp.)
OCCUPANCY INSPEC~ON
APPLICATION
DATE: [/- - :13- f?f/
I-
JOB ADDRESS: I ,,,"- J c;- /"'119-1 1\1
OWNER:~..J 6 h N N J G ;V)'J L J- t::. rc
O1olNERS ADDRESS: 1/ f.j I rl IT! tV
APPLICANT: .. , (') ~ A) ^ /1 E: /'7 ) L L E r<.
APPLICANTS ADDRESS: ) / '-J ( ),'---f 4/ 11./
FOR ACCESS TO PROPERTY - - PLEASE INCLUDE TELEPHONE NUMBER: '/ CJ- /' ~ 8" (, ') /
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PROPOSED USE: f2p,{)~(').Mijza () Ir ~ ()
A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION -
THIS APPLICATION FORM MUST BE SIGNED BY THE OvlliER OF THE PROFERTY TO
BE INSPECTED.
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SIGNATURE OF ~PROPERTY molNER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
RECEIPT NUMBER:
DATE PAID:
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DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: