HomeMy WebLinkAboutPermit Signage 1995-9-21
/
,
'25 FIFTH Slf/EET. SPfi/NGFIE/ () 01/ 0'''- ,R, BLUIP, AND SEARCHLIGHT
503) 126.3790 . /',\X (503) 12G.:fGIJ!!. ' " " SPECl ilL PE!tHIl
1I_~...~~",,~,_,~~~~1IJNITY SEHVICES DIVISIOI;
225 fifth Stl:eet
SpringLeld, Oregon 97/,77
Office:
INSPECTION LINE:
726-3753
726-3769
Job Location:
f?~ J mULA 3d1tei-
Location of Proposed Object: Q(PJ O~ ~ -~,pF1d. ,Dre. O(lY'71
Assessor~; r!ap Ii: 1'7 D335 1fJ-. Ti"" Lot II:U 07/00
Li1y,ur+cd.. motnY"s
u
5dYe.. -e..:t"
Owner:
I-lLttdlJ~ s
tG 3 IY1Cun
Sfr'~J ?leU
.::c n(' ,
9)J-747-3371../-
Address:
Phone II:
City:
State:
OR..
Zip: 0'74'77
COlltractor/ln~taller:
Address:
Phone II:
City:
State:
Zip:
Construction Contractors Registration Number:
E,-pires:
[I~scriptiol\: i+e.LllLrYl <con~_.JML~~ ]Itm p-s, W ~~~'!.J.~
Date of Installation: v~. .;2/..zr )() ~ 3071---,
Special Permit fee 540.00 . Deposit Required 5100.00
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 will be removed within ten (10) days from the date listed above. If the
above described is not removed within the timeline specified, I viII forfeit the
5100.00 deposi t. I also understand that this special permi t can be issued only
Ollce per calendar year per development area.
.Signct'tul-e
~~
-- --.
. .
b~~~
-----------------------------.-------------------------------------------------
OffICE USE
:: ~: -: ~ -:::: ~:: ~ ~:: ~ - --Z{} i -) ~ \ ~"5- -- -- m - -.. ---- -::: -: ~ --q 5-/5 2-~--
Receipt 11:(91 qoq, Issued By: ~. Y\I\. Amount COllecte~Lf-O' tJD