HomeMy WebLinkAboutOccupancy Application 1996-6-27
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD BUILDING DIVISION
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DATE: ~ - 27'-1'~ JOB NUMBER: '1 ~O !)0(p
ADDRESS OF INSPECTION: eX /-</ '-P;\ >'l p e,.- 'f-lcu- k IAl(\,(, l1 )p;;/-
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OIINER: D/"ln ~ \"f)fMr,,\::i,.., \f\f'L'\\ ^ ^ '""i
OVNER'S ADDRESS: q:L~ 13. St- ~
PHONE NUMBER: 7Yt-/7<'/.<::;-
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APPLICANT: _<'~~a_
APPLICANT'S ADDRESS: -S~.....-.-.<L_
FOR ACCESS TO PROPERTY - TELEPHONE NUMBER:
79~ - /7$/S-
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PROPOSED USE:
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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. ----
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SIGNATUREAJF~'6PERTY OIINER U
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FOR OFFICE USE ONLY
DATE PAID~ /;;n I q&
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RECEIPT NUMBER:
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DATE OF INSPECTION:
DATE OF CERTtFICATE OF COMPLIANCE:
COMMENTS:
...-....
DATE OF REPORT:
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