HomeMy WebLinkAboutMiscellaneous Application 1981-1-15 (2)
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HOUSING INSPECTION APPLICATION
EXISTING BUILDINGS
CITY OF SPRINGFIELD
BUILDING DEPARH1ENT
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DATE: J i9iJ...u4i2.<., I.:JI / r 8 I
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JOB ADDRESS: '115 /<I;,sr/1tJ DC:; G '1i ;20 '1/ p/:..'I!Ttf C)rI(.
OIVNER:h",' 'ld~A.J.v SiE.,plfclli'C;. ADDRESS: {//8
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APPLICANT: Jtt1 Lflt/lfNI
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5tfLD
NlI~IBER OF UNITS:
ADDRESS: blS' rf:ft.o,'-1';'; "J),t,
r!~( 6 t:-.;f,
FOR ACCESS TO PROPERTY - TELEPHONE NlI~IBER
7'17- 737(,
A $20,00 INSPECTION FEE IS REQUIRED AT THE TUIE OF APPLIl;:ATION.
. THIS APPLICATION FORM MUST BE SIGNED BY THE OWNER OF THE PROPERTY TO BE INSPECTED.
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frIGNATURE OF PR~ OIW'lER
FOR OFFICE USE ONLY
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Date of Inspection:
Date of Cert. of Compliance:
Date of Report:
Receipt Number:
1:;:,~\ q\ 0
REMARKS:
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HOUSING INSPECTION APPLICATION
EXISTING BUILDINGS
CITY OF SPRINGFIELD
BUILDING DEPARH1ENT
DATE: J l'7iJu t4,e<., 1.51 I cr 8 I
/
JOB ADDRESS: '1/5 N'osr/t<:1/)6 G '1i ;20 '1/ i/ot<TIf ~
OWNE R : h.v -{ d ~ fi/J;v )/E,p I!clli'C;.
APPLICANT: JIM Lflt/l1.1
ADDRESS: {II 8
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lJ/L. r!~( 6 E4Jf.
NlINBER OF UNITS:
ADDRESS: blS' r:?tt t. 0\'-1 J ;.;"
FOR ACCESS TO PROPERTY - TELEPHONE NlI~IBER
7'17- 737c'
A $20,00 INSPECTION FEE IS REQUIRED AT THE rUlE OF APPLICATION.
'THIS APPLICATION FORM NlIST BE SIGNED BY THE OWNER OF TIlE PROPERTY TO BE INSPECTED.
.~f? ~/,lL
GNATURE OF PR~ O\\'1'lER
FOR OFFICE USE ONLY
Date of Inspection:
Date of COTto of Compliance:
Date of Report:
Receipt Number:
1":' IV'<~. l1\
~_\_\ '-1\ 0
RE~lAR KS :
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