Loading...
HomeMy WebLinkAboutOccupancy Application 1984-4-23 dl= 5?LJ 0 ;:y) 5 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" (, ') / * , /; , 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. N~~1ILt SIGNATURE OF ~PROPERTY molNER FOR OFFICE USE ONLY --------------------------------------------------------------------------- DATE OF INSPECTION: RECEIPT NUMBER: DATE PAID: &,~ i,fd- Lf-d3-8~ DATE OF REPORT: DATE OF CERTIFICATE OF COMPLIANCE: COMMENTS: