HomeMy WebLinkAboutOccupancy Correspondence 1995-3-25
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e;; . Complete items 1 and/or 2 for additional services.
m . Complete items 3, and 48 & b.
e! . Print your neme and eddress on the reverse of this form so that'tJJY 'sn
G) return this card to you.
~ . Attach this form to the front of the mailpiece. or on the back if space
.. does"not'permit.
.! . Write "Return Receipt Requested" on the mail piece below the article number
.. . The Return Receipt will show to whom the article was delivered and the dato
6 delivered,' . ..
"c::l 3. Article A~d~~ssed to:
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i Sh~ir\1 SYY\i~~
~ C/o ~V\y Lu+hvra V1 Chuvch
ffi 33100 Goma. fa,m 12d
~ Spr\ V\q-Pe IcJ 02
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> PS Form 381', December 1991 1fU.S.GPO:t~.714
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I also wish to receive the
following services {for an extra
fee}:
,. 0 Addressee's Address
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2. 0 Restricted Delivery
Consult postmaster for fee.
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4b. Service Type
o Registered
!Q(Certified
-0 'Express Mail
o Insured
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o Return Receipt for :J
Merchandise ...
7. Date of Delivery ...!
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8. Addressee's Address (Only if requested..:lll:
and ~ee is paid) i
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to-
DOMESTIC RETURN RECEIPT
UNITED STATES POSTAL SER'iIIii
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Official Business
--
- --
--
Print your name, address and ZIP Code here
.
.
DEVElOPMENT SERVICES
225 FIFTH STREET
SPRINGFIELD, OR 97477
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.
.
OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD BUILDING DIVISION
._~._u_ u.. ..d.. _. _._. '.__ __ ,______________. _ ..____ __ ,__ _._u__. ...__________________ ________
..----------. -.---,,---------------------------. -- - -.----- ..---.----------------------
Di,TE: -~~C~ ?_L~:!!':5'
I\DDRESS OF ; NSPECTIor-:: ?""3~ G4~~~
n'C;1. ';l':l-t'~ '2.-.::>
O\lNER: j3e-C##/P-:Y cG.::-~c::::'i84f'~4. PIlONE NUI1BER:7--?~' 2~r
IJIINER'S ADDRESS: _?2-~h~ 4/-".;k:~~Z't-.".-
APPLICANT: --;;~&d2'l.~ _?~/-"~~ . _
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APPLICANT'S i,DDRESS: _B~:2 ~~L?J!"//-~- ~rt-r~-"22.Y~
FOR ACCESS TO PROPERTY - TELEPHONE NUl-mER: ,_:;Z2?",~~ -'j'I~t"$ ~:"S
'.~~~~~~~~=~" ==~=o,~~====~~~ ~~"~=~~~~~= ~=~~'" . ~o,_~~~ ~~~~~i'?d5h=====~=====
P!WPOSED USE: _&~~ C:::::-$='~~~-~r ~....
JCB NUI',BER:
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II $35.00 INSPECTIO:, FEE IS [mOU;.REIJ AT TliE Tl1,E OF APPLICATION
THIS APPL,ICn, \ FvO~R'IJ'1 ~ I'IIIST BE SIGNED B',' THE O\lNER OF TilE PROPERTY TO BE
pJr~~' f'D ~
~lt'~iI'~O~E' UI,'-I:[{IJP~lnTO\I~-~ .
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FOR OFFICE USE OilLY
DATE PAID:
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REcnT NU~IBER: _('t:::._~'T./ ~
OATS OF REPORT:
DATE OF INSPECTION:
DATE OF CERTIFICATE OF COIWLll,NCE:
COHl1 ENT S :