HomeMy WebLinkAboutOccupancy Application 1995-5-1
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE: .-I~/L Ztt5//'9.~
ADDRESS OF INSPECTION: --::? ~?,...,
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JOB NUMBER: ~'3'??
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OIINER: ~,(.~ ;; ?/~L?:: PHONE NUMBER:
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OIINER'S ADDRESS: ~ -j -:.:::: ~ ,., ~~~ ~. ~':S;;nE 979c::::-........
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APPLICANT: ~~~ ~~~~ h.-
APPLICANT'S ADDRESS: /~? /Ys:? #'/~ _?--:" _?~/\'t-p ";J1;?Y??
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: 72tC-/9/~ dJA .7Y~~ ~
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PROPOSED USE:/J?~~.#77~~ ~;; i.::L cF ~~.~ ?
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~~~t'$~~~~~~ FEE-IS REQUIRED AT THE TIME OF APPL;C;;IO~ -
THIS APPLICATION FORM MUST BE SIGNED BY THE OYNER OF THE PROPERTY TO BE
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SlGNATUR2' OF PROPSRTY OIlNBR
FOR OFFICE USE ONLY
DATE PAID:
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RECEIPT NUMBER:
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DATE OF INSPECTION:
DATE OF CERTIFICATE OF COMPLIANCE:
DATE OF REPORT:
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COMMENTS:
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