HomeMy WebLinkAboutPermit Signage 1998-11-10
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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:
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Tax Lot nri/yy)
Assessors Map #;
Owner of Property; ~ , ){r-~ ~ 1\ __ H!-n 0 ~
Address; ,--~!:j'70 An Q~L)AiJ
City: ,~f\J C ~ _
contractor~Jlalle~: 05-r A . t boJ c......
Address: 1'2.-\ 0 OAl?--T' .A:1L-H t4?-1:>
City: t?-~b
Ph~ne #: JQjO .EY22iXf)
Oft-- Zip: 41417
State:
Date orInstallation:
Date of Removal:
Phone #: 490. S0 410
Zip: L1140 L-
Expires: }-- / q~
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Description:
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State: 0l2--
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Construction Contractors Registration Number:
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 time line specified. I will forfeit the $100.00 deposit. I also understand that this special
pennit 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 begin the process to return the $100.00 deposit if the banner(s) has been removed.
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Signature
Date
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OFFICE USE
Date of APPliSJ;ati n: If. ((J q f<:
Issued By:, 1M)
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Job #:
q ~O~5 Receipt #: ~t\)t tV
. Amount Collected: --M.n ~
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