HomeMy WebLinkAboutOccupancy Application 1985-5-20
CITY OF SPRINGFIELD. ,
Department of Public W~s
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
.
OCCUPANCY INSPECTION
APPLICATION
DATE: /'A_I ~O / ~ <6'.5
JOB ADDRESS: .3 3 T (' r9;;/N'~) c
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OWNER: D~"'I ,Y!-PfPNtt,);..;,rJj
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OHNERS ADDRESS:
APPLICANT: J) tiJ,'
APPLICANTS ADDRESS:
<4A/1 .,0
'0-~ ~4 j/; ?~
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FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: ~A~~
PROPOSED USE:
A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION .
THIS APPLICATION FORM MUST BE SIGNED BY THE OllliER OF THE PROPERTY TO
BE INSPECTED.
/12 Z.:~-e
SIGNATUP~ OF PROPERTY Ol~ER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
RECEIPT NUMBER: 5" IS (;, Lila!1")
DATE PAID: &lUi:1j t:;-:xJ -qC;:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
850~(.5
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