HomeMy WebLinkAboutPermit Signage 2001-1-8
Jan-03-01 04:12P
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BANNER PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STReET
SPRINGrtCLD. OR 97.177
(54' J 776-.17.5.1
I-AX (541) 7263689
225 nftll Slreel
Springfield. Oregon 97417
Office: 126-3753
INSPECTION LINE: 726-3769
sannerLocation:AlqO ~tJt"k AA'lCt16 st-.
Assesson Mnp fl: /70 3 ~ -?,., o-v ._ T..... LoI --..!2_~ =3 en)
Ownerorl'roperty:. \ lVV\.~^d ~.
Addre..: ~lqn C\~~ ~ J'bon.lI: q~8-3~rog
Clty:_5pn~-hfYL State: CSf.- ZIP:C{l-'iI2
Contractor/Installer: , ..M ~
Address:
Phone U:
City:
StB~: ,
Zip:
Con$trac1ion COllltractors KeJtistr.tion Numbe.-:
Expires:
I),scrlption:
Dal, or Installation:
"T~u6'l;-:J..,", ,_
Banner I'ermit Fee $40.00
nate aIRemov.l: :r ~ J J..
Deposit Required $t 00.00
.;l.l"DI
By signature, I <tote and agree thO! I hove carefully completed this application and hereby certify that all
infonDBtioll herein is true and correct. 1 fw1hcr agru and understand that the abo\'c described banner (!;) l!:; not
larger than 60 square feet, and will be removed within 14 days from the date listed ahove. lrlhe banner(s)
lS not removed within the limelillc specified, 1 will forteit the SIOO.oo deposit. 1 also understand thai this spccinl
penn it can be i...ucd only twice per calendar year per developmc:nl area. I also agree to call the in.pection line at
726-3769 by the end of the 14th day to request BlI inspection to verify the remuval oflhe banncr(.). Thi< inspeClioll
will begin dle process to return the $100.00 deposit if the ballDer(s) has been rcmovcld.
~_~ I-?-Ol
Signature
Date
OffiCE USE
Dale of Applico1lion:
Issued By: ~
(-ct.-o,
Job#:
.m - 117rO;)C; .. () /Receipt #: l.b..o ~
Amount Colhxted: J:/Il/ O~
Lu ....e~
;:;1.:0: ~3IHSI:KJ
:39N\iH:J
OO'OV~ $ ;:;:Q:J3~ lW\i
~OOZ 80 N\if:31\iQ
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