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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.) ~ 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 ~ I FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: 72 b 97,1'0 ~ (!1! OCCUPANCY INSP~ON APPLICATION SPRINGFIELD PROPOSED USE: l j ,'> A AI. n...n "^ u L t....v,;" (. ~ A $30.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION . THIS APPLICATION FORM MUST BE INSPECTED. BE SIG~ Ott~~~~W7~~ /[, L4etfJ JIl( OF PROPERTY OIVNER FOR OFFICE USE ONLY ::~:-:~-::::::~:::~--------_._--------~:::::~-:~~:~~--~_.~~~~~;----- DATE OF REPORT: DATE PAID: ((-? /"' g-S- , . DATE OF CERTIFICATE OF COMPLIANCE: COMMENTS: