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HomeMy WebLinkAboutOccupancy Application 1996-6-27 OCV[lOf'ATrNr Sf fll/lerS nrr,1nfMCNT "s..n_"LO' '., 1 I~ I ~ y!..,"J ;';'!iI/lIll::7f/lU .... :"'!lII\'(jI-IU/J,t)J/~/,'l// (:141) /26-J/5J FAX (541) 726.3689 . @Jij)J@J3~ ~ OCCUPANCY INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING DIVISION ====================================================================i'/~======== DATE: ~ - 27'-1'~ JOB NUMBER: '1 ~O !)0(p ADDRESS OF INSPECTION: eX /-</ '-P;\ >'l p e,.- 'f-lcu- k IAl(\,(, l1 )p;;/- I OIINER: D/"ln ~ \"f)fMr,,\::i,.., \f\f'L'\\ ^ ^ '""i OVNER'S ADDRESS: q:L~ 13. St- ~ PHONE NUMBER: 7Yt-/7<'/.<::;- @R APPLICANT: _<'~~a_ APPLICANT'S ADDRESS: -S~.....-.-.<L_ FOR ACCESS TO PROPERTY - TELEPHONE NUMBER: 79~ - /7$/S- cc=ccee========================================================================= PROPOSED USE: g f\ 1--:1 " p ~~r. 1 .' A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE INSPECTED. ---- ~-r:1\'7??~/ SIGNATUREAJF~'6PERTY OIINER U -------------------------------------------------------------------------------- FOR OFFICE USE ONLY DATE PAID~ /;;n I q& -------------------------------------------------------------------------------- RECEIPT NUMBER: ()dd-d5~ DATE OF INSPECTION: DATE OF CERTtFICATE OF COMPLIANCE: COMMENTS: ...-.... DATE OF REPORT: ~~@~@~~[Q) ~[b@@~ ~[b&OO ~~@[wD~~[Q) &IJ IJDGW~ @~ &~~ti:D~&'TI'D@OO