HomeMy WebLinkAboutOccupancy Application 1988-10-4
CITY OF SPRINGFIELD
Department of Planning and Dev~pment
Building Safety Divis~
225 North 5th Street
Springfield, Oregon 97477
726-3753 (Bus.) 726-3769 (Insp.)
OCCUPANCY INSPE~N
APPLICATION
DATE: ocrD~ 3,l"')~
JOB ADDRESS:
dJ: 3SV<610
YL L~~ //6< c:;~~ C~
OWNER: At<)Ar.H~_; ro, I Ar,r=-...r, +.:,....... nw..=\
O\VNERS ADDRESS: '"'t'Lf
APPLICANT: MAf2.v A.....N
\A/. &t2:DAJ::>\'\.J A( c:,., J,- ~
, l
MAc.-IL......"'ON
~
0), 401
APPLICANTS ADDRESS: 1L.i.., T'l2-E:c 1./.1' ,
\ fnJ-'::"
l==:, )", ,~;;. D<2...- 0],4-01:)
, ,
FOR ACCESS TO PROPERTY--PLEASE INCLUDE TELEPHONE NUMBER: ~"'\z-3ZP)'5
PROPOSED USE: Nlc..l-f'l" (j....j,,)fL, /Q.~,AVt2-A....rl
,
A $ 35.00 INSPECTION FEE IS REQUIRED AT T}lli TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE OvillER OF THE PROPERTY TO
BE INSPECTED.
. I /''LOC
C;6"1 ':)"1
--udJ fJw,.,L,-"1~;"
~IGNATURE OF PROPERTY 01VNER ~ ~
FOR OFFICE USE ONLY
---------------------------------------------------------------------------
DATE OF INSPECTION:
RECEIPT NUMBER:
I 1-- t(qy
/o-L/-rt
DATE OF REPORT:
DATE PAID:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
OIL /)
\ '