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HomeMy WebLinkAboutPermit Signage 1997-5-9 . SPRa'ELD _.~ I BANNER, BLIMP, AND SEARCIJLIGHT SPECIAL PERMIT COMMUNITY SERVICES DIVISION 225 Fif th S tree t Springfield, Oregon 97477 Office: INSPECTION LINE: 726-3753 726-3769 Job Location: 5,S,~ Mo--'^ S\',.Q../> \ Location of Proposed Object:Ne,~ \_'c-\\ ~ 8\;\\&;N~; . 1'703?v;:}l, JI Assessors Map ff: ' Tax Lot II: / o...ner:n{)..()\~ ()J'\/).. 0l:O-kile., 8C1.1~'-blO , i Address: 557, Mr".,\-.A S"\,~~ Phone It: ""'7t-l'1- ("" (..,""/ City: (:,,~'~f\~~; ~\~ State: DR, 'Zip: '1lt../1~ . JUd" /J/1~' Contractor/Installer: Y/Vv r~ r J.. J{ Address: I'hone II: City: State: Zip: Construction Contractors Registration Number: Expires: Description: :KENO , , ::,\~^ V Date of Installation: '5---13 -Q,7 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 ...ill be removed ...ithin ten (10) days from the date listed above. If the above described is not removed ...ithin the timeline specified, I ...ill forfeit the $100.00 deposit. I also understand that this special permit can be issued only 0\_ "~0da,r_.y,ear:::v;::t am, 5 -~.~-'7 Signa ture Da te ------------------------------------------------------------------------------ OFFICE USE -----------------------------------.------------------------------------------- Receipt Application: II: 25731J 5-(3,-4'7 Issued By: 4/L{ ___ Job It: qr 07'10 Amoun t Collec te.tf / t(1J /{Jt) Date of