HomeMy WebLinkAboutPermit Signage 1999-1-7
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SPR.IELD
(541) 726.3753
BANNER PERMIT
COMMUNITY SERVICES DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Banner Location: .5 k.... -t. '-'D~lJ
Assessors Map #: \ J 0 ~ 'd- 0-
Owner of Property: .s k.... k ...."~ ,)
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Tax Lot
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Address:
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Phone #:
7'1(;- f'-J), 'i
Zip: 'J7 '17/
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City:
State:
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ContractorlInstaller:
Address:
. Phone #:
City:
State:
Zip:
Construction Contractors Registration Number:
Expires:
Description:
Date of Installation:
I~O;',
Date of Removal:
t!")S" /9 9
Banner 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
infonnation herein is true and correct. I further agree and understand that the above described banner (s) is not
larger than 60 square feet, and will be removed within ten (14) days from the date listed above, If the banner(s)
is not removed within the timeline specified, 1 will forfeit the $100,00 deposit. I also understand that this special
penn it can be issued only twice per calendar year per development area, I also agree to call the inspection line at
726-3769 by the end of the 14th day to request an inspection to verifY the removal of the banner(s). This inspection
will beg~ o::..7mi~osit if the banner(s) has been removed. J J 7 ) 9 7
Signature Date
,
Date of Application: \ ~ { ~ ""\
Issued By: (\ - 6V\...~<>--S-.cb
OFFICE USE
Job #: ~ ~ ()O \{ Receipt #:
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Amount CollectedA\ ~ <
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