HomeMy WebLinkAboutPermit Signage 1994-7-27
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BANNER, BLIMP, AND SEARCHLIGHT
SPECIAL PERMII
COMMUNITY SERVICES DIVISION
225 ,Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3753
726-3769
Job Location:' R~?.[), 6r\toH~ -
Location ofPt~oposed Object: ~ l~\m'{\~, ~Q..)
Assessor Hap'#;\:CBQ.QJlC'). Tay. Lot#~ DD~U
Owner. ~.) t l)Q+enUJ,flV
Address: ~Sl') _ ~ qQ fl) Phone #: -'.rl3.1133
City: &~ ~ _State:J(lpj, Zip: tJJ1fLz->
Contractor/Installer: fI) g1JL ~ 1 ~/l..L..rl4
Address: Jro.lO / Phone #:4~ .<;::S.i.J.p
City: ?l''Y'\.Of\..Q....., State:~ - ZiP:~
Construction con~-actors Registration Number: Expires:
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Description:\ ~MnS- ~ ~CJDJ~K~~t\~\ ~C
r\\.J\il\Q l_(\OiJ. J ~I'\ ~. ~.nlnD-.
Date of Installation: ~.~~-q4. =-
Special Permit Fee S40.00
Deposit Required $100.00
By signature, I state and agree that I have ,carefully completed this application
ancl'hereby certify that all information herein is true and correct. I further
agree and understand that the above described is not larger than 60 square feet,
and will be removed within ten (10) days from the date listed above. If the
above described is not removed within the timeline 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 area.
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Date
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OFFICE USE
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Receipt
Application: 1.2.'7. q4
#: \4rf5'f Issued By: ~,)
Job #: Q4DQLo7
Amount Collected: _~[).~
Date of