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HomeMy WebLinkAboutPermit Signage 1996-6-17 . /~ . .. - :.iP")INC'-:IF-LO BANNER, IlL!M?, I,ND SEAR(;HLIGHT SPECIAL PERlHI COMMUNITY "ERVIeES DIVISION,,- .,.' ".,' "';.:'1~; , ":<7ob'Locaii-on:' 3/gg '6OU-~~ /-oW;' LOca t'~on of?~oposcd Obj ec t :Sol.-Cf% '!Slat o{ 15'u, '/ tJ 1m '-- .._,.~ //lI/OZ5 ,/ ' Assessors 11ap ft: /708 Z2 20 03-::v-v""1 Tax Lot ft: d:?T1 _b-~~~ -b~ClJ'(\c\ .w-. __, Phone ff: g~- LR=ito .76:t."">.'- Slate: {JA Zip: q$2/9 Office: 726~3753,,: INSPECTION LINE;, )26,~3769 ' ,~<"',~':, I.' ,:'.' 225 ,Fifth .Street . . '\',:;:'Springf,ield, Qregon ,97/,77 " " \.\.r.-.~";:":'. ...", ~ , " . ,', ;~ ;~~;x. ~':- .~'"',,. I" . Owne r: 1 - Address: 2ZlD:.~ ~.QJ>(A)b City: ~()JU'iJlO {\\ ()f\O f.~ Contractor/Installer: Address: Phone"ff: City: Stato: Zip: J Constru~tion Contracto~s Registration Number: . ,Expi res: . DG:scdption; l~o ,\ ~i\rudJ Da~e.. o~_I~sta.lla.ti.on: '- \\ ~ f\Q..,~l 0 \\qC\(O ,....;r-f~r~ Special Permit Fee $40.00 Deposit Required $100.00::' By SigIlBt\IU, I $tate and agL'ee that r ba'l'" .carefully' completed this' application and 'hereby 'cettify that all information herein i_ true and correct. I further agree and understand that the above described.is not larger than 60 _quare feet, and ...ill be removed within ten (1.0) days frOm the date listed above. If the above described is not removed within the tim~line specified, I will forfeit the, $100.00 deposit. I also understand that this special' permit can be issued only once per calendar year per development arq., -. _' v1&U1J rWyol $.gnature ~ . .,.r ~/l' Date , -~--------------------~------~---------------'---------~----------------------- OFFICF; USE - ------- -------------- -- - ---- ----.... ~---- ------- --.. ---- - -- ---.... --- -- ---------~ e::: Date Q'f APpl~~~~nl: lo cQ.G<J(O.~ Job ti: C\\cD~8--.:> Recei~t It: ~ Issued By: ~myo\lnt Collected: M'l)'W