HomeMy WebLinkAboutOccupancy Application 1987-2-2
CITY OF SPRINGFIEL.
Department of Planning and De ,pment
Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE8ItON
.,11 APPLICATION
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SPRINGFIELD
DATE: FFl,\2.uA-<2--r 'Z.. \'"\ ~l
JOB ADDRESS: / "" ~S- 1', I A" -.-..\. c:-.. "'2>\.
OWNER: J>1=:.t..J"-.l \ c:;.' e.. E.. ~ \.>
OIoJNERS ADDRESS: zB ~6 "C>\2.'i C, ulC ~. 3' PrC..'f::. <:;,u-J l.U T
APPLICANT: SPrLt?- ~ ~~~\' C-d"ri.'-'\&=-F
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APPLICANTS ADDRESS: 16S7 ~D\~SC:>f-.-1 u.J. SPf?JrJGI::'/cCD crt<:\' 77
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:
"'-^- ~ '?-E.. E.. v (~<.., "7 L c... - ~ s:- z.. ""
PROPOSED USE: C',\.\.1l D. CAe.~ r- A<.~ U i"'\ - z.o C.~-\I LD\c.\S~
A $ 35.00 INSPECTION FEE IS REQUIRED, AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE o.rnER OF THE PROPERTY TO
BE INSPECTED.
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SIGNATURE OF PROPERTY OIoJNER '""7. ,"'II ~
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FOR OFFICE USE ONLY ~ oWilJ~ ~ ~\C.A-i--ll
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DATE OF INSPECTION:
RECEIPT NUMBER: f? t, 7?LfLj
DATE PAID: :2 - ;2 - ff' 1
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: