HomeMy WebLinkAboutPermit Building 1986-8-29
CITY oF' SPRINGFIELD&'
Departn~nt of Planning and Dev~ent
Building Safety Division .
225 North 5th Street .
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
DATE:
JOB ADDRESS:
SPRINGFIELD
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HOUSING INSPECTIO~
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APPLICATION
OHNER:
m.JNERS ADDRESS:
APPLICANT:
APPLICANTS ADDRESS:
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:
A $35.00 INSPECTION FEE IS ,REQUIRED AT THE TIHE OF
APPLICATION .
THIS APPLICATION FORM MUST BE SIGNED BY THE Ow~ER OF THE PROPERTY TO BE
INSPECTED.
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SIGNATURE OF PROPERTY OVJNER
FOR OFFICE USE ONLY
--,-----.-----------------------.--.----------------------------------------------
DATE OF INSPECTION: '1" 3 -gJ~,~~ --RECEIPT NUMBER: R h~CjCj }
<7- ~ - sb ~ DATE PAID: ?),.2R-71o
DATE OF CERTIFICATE OF COMPLIANCE: or - 3> -~ '= ~.,
DATE OF REPORT:
C011HENTS: