HomeMy WebLinkAboutSpecial Inspection Occupancy 1993-1-21
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OCCUPANCY INSPECTION APP~ICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE:
/-Z/-t93
JOB NUMBER: a~~
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~~.e'/~/~ I O,e. 97q77
ADDRESS OF INSPECTION: ;?/~ (t1 ~
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O\lNER: /#/Vr/ez2J ~t?/.?'8'R7Y PHONE NUMBER: ~M-L/tj/tJ
O\lNER'S ADDRESS: 87/ &V'"w-~y !!LuLl ~}), Et/C}e:;r..Ie-,d/f, c;7t/o/
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APPLICANT:
4eT>~L /~ ~ 5'76va- J 4rrer
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APPLICANT'S ADDRESS: ~/8 /1./, 21ST S'l:?/V.tUc;RA7 >-. / (J~ I 97C177
FOR ACCESS TO PROPERTY -.TELEPHONE NUMBER: ?/f7 - 0"S77 kr ~L:I/UC
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PROPOSED USE: SCPt/~ iJ~" <3/~~6EV61JTS'JMI,()t3fS&AI(/B",Wit7I./S
j?U4zJ.41~ pAMJg &;';/l~1 !JJ/?f@"2)Y, - /ti:/l!Jf?;:YA0t'U3.'/a-VIl/AlS
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A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE O\lNER OF THE PROPERTY TO BE
INSPECTED.
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StGNATURE OF PROPERTY OVNER - l
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FOR OFFICE USE ONLY
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DATE PAID:
)- 2-7- -<] '~
LECEIPT NUMBER:
/32-2--
DATE OF INSPECTION:
I'ATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: