HomeMy WebLinkAboutPermit Signage 1994-8-2
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SPRINGFIELD ... .._0.1 . I
: BANNER, BLIMP, {,ND SEARCHLIGHT /
SPECI AL PERMIT
COMMUNITY SERVICES DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Job Location:
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Location of Proposed Object: Q(PJ. ~ ~ -Sn:>F<d.. ,l'Jre. 9'7471
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Assessors Map~: I D3~::> If..;,. Tax Lot~: 0 /00
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Address: g(p 3 fY1~ cSltre..-e..--t'
City: ~rll\.Jhe1<.
O"ner:
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Phone ft: 5)J- 747-331l.f...
State:
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Zip: Q.7LfT1
Contractor/Installer:
Address:
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State:
Zip:
Construction Contractors Registration Number:
Expires:
Description: I+eJ.L~in ~':> ~5 ]l,m P.s (J;J.. ~U:
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Special Permit
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Fee $40.00
CNL Sept 8 - SepT, q
Date of Installation:
Dep0sit Required $100.00
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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 i~ not removed "ithin the timeline specified, I "ill forfeit the
$100.00 deposit. I also understand that this special permit can be issued only
once pel' calendar year per development area,
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Signa'ture
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OFFICE USE
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Date of Application:
Receipt #: il.-l '1-L~~
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Issued By: (~
Job #: qYI2.-11
Amoun t Collec ted: 1<-\0. ()7)