HomeMy WebLinkAboutOccupancy Application 1988-2-8
CITY OF SPRINGFIELD
Department of Planning and Dev~pment
Building Safety Divis'"
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPEC~N
APPLICATION
SPRINGFIELD
/0,25#8800"7';>
DATE: 2~&-&,&
JOB ADDRESS: / 7/,5' ~.N~<=A" P.;r/7"~/A/-4-7-" C=-....-9s.-7'
OWNER: 15.#?-,"'"';? ~/77E~.2::>
mmERS ADDRESS: / 7,,;:;, !vesT C' <;;7:
APPLICANT: 7-?A-c,7J?L 5'/.7C'e-.z:.:>
APPLICANTS ADDRESS: ::;~E.
FOR ACCESS TO PROPERTYnpLEASE INCLUDE TELEPHONE NUMBER: 7</,;{, -~:z 9-=5"
OIN'/Yc~s .~h7C=-?~.-'9''''''::- C/7f Alr /~S" h'~?r &AY..v_~ ~..,...;
PROPOSED USE:.gc-'h?.,::>/-::>=c ot... p ~c-~/C .5}-<=->?'f"'e- /'ii3 4-o::""__~/<::-'
~~,4' .)n:.:vrc=-=~ '/"'V-?"d<.,~,?C=- .5/"C!:>,-j"'c::?
A $ 35'.00 INSPECTION FEE IS REQUIRED AT THE TIME
(~) OF APPLICATION '
'16".{. I III J
THIS APPLICATION FORM MUST BE SIGNED BY THE OvmER OF THE PROPERTY TO
BE INSPECTED,
i2f!dA < .' /
SIGNATUPro;-;ROPERTY~ plmER
FOR OFFICE USE ONLY
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DATE OF INSPECTION:
RECEIPT NUMBER: J~~~b
DATE PAID: -:::(-$'-S-B
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
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