HomeMy WebLinkAboutOccupancy Application 1982-4-6
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OCCUPANCY INSPECTION APPLICATION
EXISTING BUILDINGS
CITY OF SPRINGFIELD
BUILDING DEPARTMENT
DATE: __Afild.l- to.!..i.x 2-
JOB ADDRESS: ;278 7 (JLi,nf'/'- _
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NUMBER OF UNITS: !)AlE
OWNER: t..f) Sin/ill
OWNERS ADDRESS: " W UJ - /O/, ,S'
APPLICANT: HI. Ke.uIAJ JJNM
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APPLICANTS ADDRESS:
FOR ACCESS TO PROPERTY - PLEASE INCLUDE TELEPHONE NUMBER: GfAJ~7
(Pin VI. -+V' ,,- 5? 1-<' Y'
A $24.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION
THIS APPLICATION FORM ~ruST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE
INSPECTED.
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s'r~J. 1ft' Of' ~OPB TY OWNER-
__ _ _ _ _ __ __ __ _ _ _ _ _____ _ __ E:Q!l-_ QfngL Qg~~-__ --____ - -- - -.. . -- --- - -- - -- - -- -----
DATE OF INSPECTION:
DATE OF CERT. OF CONPLIANCE:
RECEIPT NUMBER: ~'6~ 8.
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DATE OF REPORT:
REMARKS:
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