HomeMy WebLinkAboutPermit Signage 1997-9-10
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'6'503.6 3689
S~FD DEI', SER,.
~002
SPRINGFIELD
,
225 Fifth Street
Springfield, Oregon 97477
BANl'oER PERMIT
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COMMUNITY SERVICES DIVISION
I
225 FIFTH STREEE:T
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
Office: 726.3753
INSPECTION LINE: 726-3769
Banner Location: 5--rtJ/Lg ':-~~IL, ~\O\~ G.
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Owner of Property: r A- RK 1=1e --t{; \i f\ Au n 0 ~
Address: ---AI {} 2. GH'EI./J~ Mn/ Phone II:
City:;5e;? /N ~ 1=/ z L j) I State: cJ ~
contract~ ~..e...f-~.I~ 11 9-
Address: '. .3ct-2--~~<),r~ drp_
City: .:f.4..,-$" ~ A L. 1: (/ j L State: ?"\ .;!
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Construetlln Contractors Registration Number: I Expires:
'.,1/ 1-::;71 :
Deseription:_0."l ( )' 2-0 ~~
Date of Installation: ~/'7 I Date of Removal: / r c:t.Ay <:
Banner Permit Fee S40.0J Deposit Required $100.00
By signature, I state and agree that I have carefully LmPleted thi.'l application and hereby certify that all
information herein is trUe and cOlTect I further agree imd 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)
i.'l not removed within the timeline specified, I will forfeit the $100,00 deposit I also understand that this special
permit 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 bonner(s), This inspection
will begin the process to return the $100,00 ~r,' osit iffue bonner(s) has been removed,
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Signature /1 . Date
Assessors Map #:
Tax Lot
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71-/-11 99
,
ziP:-.!l-74'12
Phone #:
ziP:1/~~7
Date of A~pli~ti9n: q, \ C) ,0. ~
Is~ued By: '-"O\\f:)n )
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OffiCE USE I
Job #: CJ\ ~ 134 Receipt #: & ~~ 0
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Amount Collected: \4i),