HomeMy WebLinkAboutOccupancy Application 1985-11-7 (2)
CITY OF SPRINGFIEL~
Department of Public ..,ks
Building Safety Divislon
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
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DATE: //-7-?S' ~ t"S! 0(0 d-
JOB A~DRESS:~~.~O VLY:&EtLr ~PRJ1NlaD12r.
OWNER: paEtZ. Lt\eA<<tt LACAVA- .
mVNERS ADDRESS:~ .,:OR - WAltVUT C2CEK; eAqg.~b
APPLICANT: )r)/kp ,,/'-h'rJ.plr
APPLICANTS ADDRESS: 3 o~ /I) 74-(;/. J.f. J-fJrn';~ /;,.M {)r Q7t/-7A
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FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: 72 b 97,1'0
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OCCUPANCY INSP~ON
APPLICATION
SPRINGFIELD
PROPOSED USE: l j ,'> A AI. n...n "^ u L t....v,;" (.
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A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME
OF APPLICATION .
THIS APPLICATION FORM MUST
BE INSPECTED.
BE SIG~
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OF PROPERTY OIVNER
FOR OFFICE USE ONLY
::~:-:~-::::::~:::~--------_._--------~:::::~-:~~:~~--~_.~~~~~;-----
DATE OF REPORT: DATE PAID: ((-? /"' g-S-
, .
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: