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HomeMy WebLinkAboutOccupancy Application 1984-3-21 CITY OF SPRINGFIEL~ Department of Public h ~ s Building Safety Division 225 North 5th Street Springfield, Oregon 97477 726-3753 (Bus.) 726-3769 (Insp.) APPLICATION ~?CJ1 ~J ~ ~TL.)~ M ~ DATE: ~ - 7 ( -5((./ . .". . <f^- 3/'d'v>Vt:J? JOB ADDRESS: 2r '67 o(~{u~ s.--+. -t+i;7 OWNER: "-r:u..,,,,,,? /)rc-p-e,:j.../ /1IJ~-"':_j.R-~'f7I'W..J (", / fk;1//A:Is -Iz,,,, C'1._j)~/\ ---;>'"' . (' ~;::- / mVNERS ADDRESS: /1 II ?.~cvJl.sJ- .!'UIC4>-P' ~ 97'177 APPLICANT: fY) 'I c:1 "f C1 AV-1 - J I APPLICANTS ADDRESS: 0:;;"2. La (()e "lr\ ,. .i' FOR ACCESS TO PROPERTY--PLEASE INCLUDE S..o-r !r;i. - ( TELEPHONE NUMBER: 7C/7' (,3~ 711- 0357 PROPOSED USE: /nl'Yl m '\ <;" <: v Li I WC...--( k a<., <;'-f' A $30.00 INSPECTION FEE IS REQUIRED AT T}lli TIME OF APPLICATION THIS .6..PPLJ.CATIC!'1 FQPJ1 HUST BE S:!:CNED E'! THE o~'mE~ OF THE PItOPERTY T8 BE INSPECTED. (""1,d,_ / Act'" t ~I ~ SIGNATURE OF PROP{R;yVOlVNER - FOR OFFICE USE ONLY --------------------------------------------------------------------------- DATE OF INSPECTION: ~;hy . <\~qJL RECEIPT NUMBER: lo'LLo2:f7 DATE PAID:l.ffi(\]\ , 2...L.~B4/1 dlffiill!;;'~ 11 IV~ U&~ :lM4~ / DATE OF REPORT: DATE OF CERTIFICATE OF COMPLIANCE: CO}1MENTS: ;i)/.Jn,t,,:Oj AhulJ /H~/I. oK. . ,)j: I._n 7.",~qo / ,,/~ ~ / CITY OF SPRINGFIEL. ' Department of Public \ ks Building Safety Division 225 North 5th Street Springfield, Oregon 97477 726-3753 (Bus.) 726-3769 (Insp.) . OCCUPANCY INSPECTION APPLICATION ~9c-q (..J,Jt~wJ ~ ~-C-U):... M ~ DATE: ~ - 7. ( -~ .. . ", .' \ O"'rv 3/~~\'b? j JOB ADDRESS: 2'7 't7 O~ S:f-. -f:t~ OWNER: :r;~.A'N'U (l~ Mlj~?O?V'4J (...." /!.&r:?Ais -hy c>Wl~ m-mERS ADDRESS: /J / I ?~C<A..fl sJ- t:"'-;1&?4>-P- , ~ Cj 7</77 APPLICANT: /Y) ]r.- (1 re Cj pfV'-f V - () I APPLICANTS ADDRESS: ~-ZLo (YIe'lir, 5p~I(J I .1' THIS APPLJ.CATIC!'! FGP11 MUST BE SICNED B'! THE O~'7NErr OF THE PROPERTY TO BE INSPECTED. -L~g~Uk,j-~f ~ SIGNATURE OF PRopfRTYllm-mER - FOR OFFICE USE ONLY --------------------------------------------------------------------------- DATE OF INSPECTION: DATE OF REPORT: DATE OF CERTIFICATE OF COMPLIANCE: COMMENTS: RECEIPT NUMBER: lo'lLoa7 I DATE PAID:,J'{\M . t.'l.~ e4/1 dJJA~ · v t (r