HomeMy WebLinkAboutOccupancy Application 1992-9-22
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OCCUPANCY INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING DIVISION
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DATE:
'5~~ 2--2-, IQerz
JOB NUMBER:
q Z/38(a
ADDRESS OF INSPECTION: ~O~___A~~,
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OWNER: tJAllVrrY... UI~WIAN ~_CkftJRcH
PHONE NUMBER: -r~--~~1
OWNER'S ADDRESS:
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APPLICANT:
1;' A;-rJ{,- \/J A-f?-i I A ~
APPLICANT'S ADDRESS: +0 I E :=S"Z-I\.d ~~ <f7-+o S'
FOR ACCESS TO PROPERTY -' TELEPHONE NUMBER: ~... l~~H.A 7;.ftf-2ZG4(~K:)
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PROPOSED USE: r 1J\2.~ : c51?'),2.A.c:.~ 5C ~f>
'Y/2.0PD~D : (/)NVfZfC:r-<:j'~1 ~ I.~) {V.~I/~ / t;.-LA':56 ~M.S ~ IWICE'
L.EA.~ 'f'~ /Jc> l.J..bf>:--' 'Sf>J.c..e. / ~P' ~'1 ~..
A $35.00 INSPECTION FEE IS REQUIRED AT THE TIME OF APPLICATION ~hr.5/MO~
THIS APPLICATION FORM MUST ,BE SIGNED BY THE OWNER OF THE PROPERTY TO BE 'lro~~.
INSPECTED. .,
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OWNER '. I
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SIGNAT RE OF PROP
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FOR OFFICE USE ONLY
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DATE PAID:
q -- 7~2- -CZ?
RECEIPT NUMBER:
&Z~/
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DATE OF INSPECTION:
DATE OF REPORT:
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS: