HomeMy WebLinkAboutPermit Signage 1995-6-27
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S~RINGFIELD
BANNER, BLIMP, AND SEARCHLIGHT
. SPECIAL PERMIT
COMM\INITY SERVICES .DJVISIOI,
225 Fifth Street
Springfield, Oregon 97,77
Office: 726~3753
INSPECTION LINE:'. 726-3769
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Location of Proposed Object: \Q", Q-i)\\c1\M
Assessors Map #: \\D^-;)c::N2- Tax LO~ #: O<@Qrl)
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City: ("",\r\M_ ~Io~ ..... State: ~. . Zip: Q1:'1'&<6
O,onq,.actor/lnsta11er: .~., '. .......,.I.uQQot\n~_O. ...'~~.. A~Ollli'P\.' .. ". .'.
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Job Location:
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State:
Zip:
Construction Contractors Registration Number:
Expires:
Description:
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Dat~ of Installation:.
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Special Permit Fee $40.00
Deposit' Required $100.00
By signature, I state and agree that I have.carefully completed ihis application
and'hereby certify' th.t all information herein is tru~ and correc~. I further
agree and understand that the above described is not larger than 60 square feet,
and will be removed within ten (10) days from the date listed above. If the
above des'cd bed 'i!j not removed wi thin the . timeline-. speci tied; I will foriei t the
$100,00 deposit. I also understand that this special permit can be issued only
. O~:;dar ~el~ development area. 6--;;;7-76
~~nature IlZ ['ate
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OFFICE USE
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Date of Application:
Receipt #: ~
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Is:ued By: ~ ~Amoun t Co11ec ted:
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