HomeMy WebLinkAboutPermit Signage 1998-1-13
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DEVELOPMENT SERV.nis CZ~TMENT
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Assessors Map #: I I OJ. ,;;2.. 1.f/-f Tax Lot :J.1r?O 0
Owner of Property: ~~ ~ $1D 'Td~ ~
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Address: d ~^ W/L--f Phone#: 7(;(~- RY<? 7 -Ml11wS
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City: '3v/7drLd' State: t!7/C Zip:?/ 7</ 77
Contractor/Installer: ~
Address: .....--
SPRtt:'ELD
BANNER PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726,3753
FAX (541) 726-3689
Office: 726-3753
INSPECTION LINE: 726-3769
Phone #:
City:
State:
Zip:
Construction Contractors Registratiou Number:
Expires:
Description: ~~~. ~ ~
DateofInstallati:: ///5/41' Date of Removal: /1.10 /-r ff
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Bauner 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
information 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 (l4) days from the date listed above. If the banner(s)
is not removed within the timeline specified, I will forfeit the $ I 00,00 deposit. 1 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 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
OFFlCE USE
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Job #: ,Cf 100l.{'( Receipt #: 0 L "l t.f b I 7)0/.
Amount Collected: :iLL! 00
Date of App1icati~:
Issued By: 'rt..
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.j- $/00.60
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