HomeMy WebLinkAboutPermit Signage 1997-5-9
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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
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Address: 557, Mr".,\-.A S"\,~~ Phone It: ""'7t-l'1- ("" (..,""/
City: (:,,~'~f\~~; ~\~ State: DR, 'Zip: '1lt../1~
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Contractor/Installer: Y/Vv r~ r
J..
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Address:
I'hone II:
City:
State:
Zip:
Construction Contractors Registration Number:
Expires:
Description:
:KENO
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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
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OFFICE USE
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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