HomeMy WebLinkAboutPermit Building 1997-5-30
DEVELOPMENT SERVICES DEPARTMENT
'*
BANNER, BLIMP, AND SEARCHLIGHT
SPECIAL PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726.3753
FAX (541) 726-3689
225 FH th S tree t
Springfield, Orego~ 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Job Location: IAc,,~ Lf/t1}rdf '?.,
Location of Proposed Object: f J1t-rl1J/ (If ~a.... or Q
Assessors Hap #: I,?A"''2-~/t:) Ta;.; Lot #: 0 3l}'o~
Ovner: J "AJ~ /J 'J12Jt':.N.-r :
Address: b (,.n t.BveL- llJA..J'F<
Ci ty: ~P~f\Jft7~46I..'/)
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Phone #: ') 410- 152. '5'8
State: e>rL Zip: ?14'1'1
Contractor/Installer: ~~~
Address: Itt:jh~ L~ 7'r
Ci ty: ""'5" ftz.;iV& t:i h ~
~~ ItJ~. 2er-A-~
Phone #:~-/Z7)
State: c;:If2 Zip: Cf'/4'7?
Construction Contractors Registration Number:
Expires:
Description:
12 wT - A. /Df267.b<
Lo~ 13L..tmf'
Date of Installation:
~J ~_ qr"J
Special Permit Fee $40.00
Deposit Required $100.00
By signature, I state and agree that I have carefully completed this application
and hereby certify that all information herein is true and correct. I further
agree, and understand that the above described is not larger than 60 square feet,
and viII be removed vi thin ten (10) days from the date listed above. If the
above described is not removed vithin the timeline specified, I ~ill forfeit the
$100.00 deposit. I also understand that this special permit can be issued only
once per calendar ar . evelopmen t area.
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bate
Signa ture' ,
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OFFICE USE
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Date of Application: 5-30 -77 Job #: 970?..J9
Receipt {)l.597 Ii- Issued By:17. rnt<.dttUlfjnount COllected:/! ILl-G. av