HomeMy WebLinkAboutPermit Signage 1993-9-3
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SPRINOFIELD
BANNER, BLIMP, AND SEARCHLIGHT
SPECIAL PERMIT
COMMUNITY SERVICES DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
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Job Location: Rl nI'6\\\l1 \f\ ) (B\'?\F\()"\
Loca t ion of' Proposed Obj ect: .
Assessors Map #:flf)()~D,",'L Tax Lot #: Ofl \l'L)
Ovner:\ ~\d:0\1\ '\ f\S ,-"'\\"0- ~(\yto(t ~t):r-[)~
Address: P)l ()~ ~() Q _ t\_) Phonedt.:. ~f\ -30~..j.
City: q~ \-'\\~J \<1 State: ruM~~ ZiP:L\J1: 7
Contractor/Installer: .~
Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration Number:
Expires:
Description~ P-1\f\~O~ ()lfrn-~ ~ \2il1J~
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Date of Installation: O~t) q} \qq3
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 viII be removed vi thin ten (10) days from the date listed above. If the
above described is not removed vi thin the tirneline specified, I viII forfeit the
$100.00 deposit. I also understand that this special permit can be issued only
once per calendar year per development area.
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Hutchins Springfield Toyot.a .
@T~~O~;:Benz ~
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Richard Derrick Q &;tt Y71a'l(~
Sales Representative V /Je<<J Pa,... /'YIt1lJdi _____
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800-888-6305 863 Main Street
(503) 747-3374 Springfield. Oregon 97477
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