HomeMy WebLinkAboutPermit Signage 2000-10-31
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225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726.3753
FAX (541) 726-3689
BLIMP, SPINNER, PENNANT, BALLOON, SEARCHLIGHT PERMIT
COMMUNITY SERVICES DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Location:
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Assessors Map #:
Owner of Property: Lt'-fi (',,- ~'-'10~
Address: 'Xh ~ /l.f fA ~ v-.. ";3-T- I
City: _<Pn'J..r:e- tL State:
contraetor/fnstaller: , It b AJe--
Tax Lot
Phone#: 7cf7-.337c.(
02- Zip: Cj.::;C/:;z ?-
Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration Number:
Expires:
Description:
Date or Installation: ~ / Q0
Permit Fee $40.00
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Date of Removal: (;/~O
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 display will be
rcmoved within ten (10) days from the date listed as the date of installation above, If the display is not rcmoved
within lhe time line specified, I will forfeit the $100.00 deposit I also understand that this special permit can be
issued only once per calendar year per development area. I also agree to call the inspection line at 726-3769 by the
end of the 10th day 10 request an inspeclion to verify the removal of the display. This inspection will begin thc
process to return the $100.00 deposit if the display has been removed.
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Date
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OFFICE USE
Date of Application:
Job#:
Receipt #:
Issued By:
Amount Collected: