HomeMy WebLinkAboutPermit Signage 2000-10-30
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SPRINGFIELD
BANNER PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726.3753
FAX (541) 726.3689
225 Fifth Street
Springfield, Orcgon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
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Assessors Map #: ( 7 0 ~ ?, )<-( L-
Owner of Property: L..t~!C\.. lOlof",-
Address: X'<D3 /VI c.; V"\. s-+-
City: Srr.V\JC'.", Irt
ContractorlInstallcr: A 10 A \ G:
Tax Lot 0900
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Banner Location: ~€G MAO
Phone #:...75L7 3 ~ 74_
State:
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Zip: 17477
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Address:
Phone #:
City:
State:
Zip:
Constructiou Contractors Registration Number:
Expires:
Description:
Date of Installation: ! if /00
Banner Permit Fee $40.00
Date of Removal: / j/; \/0 (')
Deposit 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 banner (s) is not
larger than 60 square feet, and will be removed within 14 days from the date listcd above. If the banner(s)
is not removed within the timeline specified, I will forfeit the $100.00 deposit. I also understand that this special
permit can be issued only twice per calendar year per development area. I also agree to call the inspection line at
726-3769 by the end of the 14th day to request an inspection to verify the removal of the banner(s). This inspection
will begin the process to return the $100,00 deposit if the banner(s) has been removed.
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/0' 30-00
Date
OFFICE USE
Date of Application:
Job#:
Receipt #:
Issued By:
Amount Collected: