HomeMy WebLinkAboutPermit Signage 1997-5-21
.
.
SPRINGFIELD
BANNER, BLIMP, AND SEARCHLIGHT
SPEC1AL PERMIT
COMMUNITY SERVICES DIVISION
225 .Fifth Street
Springfield, O~egon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Job Location: ::JI rVla.-iJ,du.-J ~ffVlOa<f> ~'~:I'>jut"- 6/0 '17'1-71
Location of Proposed Object:~d.R..-pt.J ~
Assessors Map#: 1'7031J..4t-.( . Tax Lot #: 07f/:7OD
O;rner: ~~t4qrrp~dJ~ 6U7IJ/5tl5: "ma,tin:W.- r,;,//I/HrdLl.u.f~ ~n.\!Q..I)
o ~ . 7'/-;-;"-;;-/.J;f.s~ .
Address: Jo'1~ctU.J&.iJ~ Phone #: 7'IU-$97'/ "lnmwS
v
City:
Jb#
~.
State: ~
Zip: ('7'17/'
Contractor/Installer:
~~LP
Ci ty:
7J/tl
'7i!tt...
l'hone.#:
Address:
State:
Zip: . "7h
Construction Contractors Registration Number:
Expi res: ;;zr4:
Description: ~{il7nM/~ IUw~: fhehl7:zle.. ClJzwtVz~~!tJ,l'Md~l7Z'a2..t/
Date of Installation:
oK./- . q
~'te..- lrr
! 5 .2J .q 1
Special 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 is not larger than 60 square feet,
and ;rill be removed ;rithin ten (10) days from the date listed above. If the
above described is not removed ;rithin the timeline specified, I ;rill forfeit the
$100.00 deposit. I also understand that this special permit can be issued only
once.per calendar year per development area. '
. ~~~~_~ ~7n!lU~
Ugnature G ()
_ sj.z/lr7
Date
------------------------------------------------------------------------------
OFFICE USE
------~----------------------------.--------~------------------71~-------------
Date of Application: ~'~...\~1 Job #: '--\l.a~D4
Receipt #: c0.S~<jsslled By: ~~ Amount Collected: \4\\~J