HomeMy WebLinkAboutPermit Signage 1998-6-22
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DEVELOPMENT SERVICES DEPARTMENT
BANNER PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Banner Location: '?ll q ~ r,..,jl J~I in G { ~
Assessors Map #: ,Tax Lot
Owner of Property: ~\.\~"I' k ~^"".\/l ~L ,<"'A.Jlt.
Address: ;f..~9n (i4JJ I Il.- ~ ([\ A ' Phone #:
City: fA li{ A JQ State: e (
Contractor/Installer: C 'J--r\ .Q/
Address: a,,~ '" t>f-=. ~ l -,?J , Phone #:
('!n322 20Z,5CC
_:<"47-33\\
Zip: 9tl{D/
City:
State:
Zip:
Construction Contractors Registration Number:
Expires:
Description:
Date orInstallation:
~ l7:1 b.r
Date of Removal:
1(~I(tjr-
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, I will forfeit the $100.00 deposit. I also understand that this special
pennit nl twice per calendar year per development area. I also agree to call the inspection line at
726-37 e end of . J '" ...~""'~. :""e"':~ the removal of the banner(s). This inspection
the $100.00 deposit if the banner(s) has been removed.
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OFFICE USE
Date of Application: ,h"-"::l ~ '~SiiL Job #: .--::-.o.C.....~?l,I'~ Receipt#: :::?dc,/::<2
Issued By: ~~? ~ A~untCollected: >4/4:-. ~