HomeMy WebLinkAboutOccupancy Application 1987-2-2 (2)
CITY OF SPRINGFIELD'"
Department of Planning and Dev~ment
. Building Safety Division
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPEC~N
APPLICATION
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SPRINGFIELD
DATE: FF.-&f2.0M2-.. -z., I ~ B 1
JOB ADDRESS: I b <;"S- 1\ I A:~~.....t ~ "'2> \..
OWNER: J>~t0~\~ e..E..~ D
mvNERS ADDRESS: ZB~o 1::>\2."i C,ULC~. 3'p'<"~c:;,~ LU T
APPLICANT: SPrL'I- ~ ..s-~c...\' (""7~'-1.&=F
APPLICANTS ADDRESS: loS? ~D\~S6'J (J..J, SPf?,uJ(;(::'tcCD S,d, 7,7
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FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER:
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PROPOSED USE:~,~\1 ~ CAe~ FA-c..\U'i"'\ - z.u C\-\ILDI<;:\:::..f--1
A $ 35.00 INSPECTION FEE IS REQUIRED, AT THE TIME
OF APPLICATION '
THIS APPLICATION FORM MUST BE SIGNED BY THE OvlliER OF THE PROPERTY TO
BE INSPECTED.
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SIGNATURE OF PROPERTY OHNER .-..,.;=11 ~
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---------------------_:~~-~:::~:_~~:_~~::_-~-~~~~-~-~~~~-~---
DATE OF INSPECTION:
RECEIPT NUMBER: IS //7?LJ'Lj
DATE PAID: ;< -;z - f?1
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: