HomeMy WebLinkAboutPermit Signage 1996-4-16
.
It:
SPRINCFIELD
BANNER, BLIMP, AND SEARCHLIGHT
SPECIAL PERMIT
COMMUNITY SERVICES DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3753
726-3769
Owner:
Cfllri)
*
.
Job Loca tion: ~\ O~ \J'{'lhf\
Location of Proposed Object: ~ \.(i\\t (If'tA
aPl*~m~1:A~- Tax Lot ft:
A~dress '\ _ . - '\'{\Q 0 (\
Clty: ;\~~
Contractor/Installer:
Phone ft:
State: (9-f-->
Zip: q7Lfll
(Ql_1)niLJ
Address:
l'hone ft:
City:
State:
Zip:
Construction Contractors Registration Number:
Expires:
O"~"P'j",,~l\1\Qy;:,J \_~111flj) I' t-V{'..J
Date of Installation: ~~Q~.~~
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 will be removed within ten (10) days from the date listed above. If the
above described i~ not removed within the timeline specified, I will forfeit the
$100.00 deposit. I also understand that thi~ special permit can be issued only
"" '" "j"::'-;J~,~~'"'j""" ",,-
Da te LI-/J-b-J3-1o
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OFFICE USE
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Date of Application: 4-' \\0 \~ ~I~^, Job ft: C\ \QD1(jU)
Recei~t ft: J\ \~~Issued By: ~K~ ) Amount Collected: \L\l) ,DO