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HomeMy WebLinkAboutPermit Signage 2000-10-31 . . * 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: /lfn'-:S /!JIA,-h '7 C;p[: (d DIJ2-- c; 7 97-1 -' . 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 :J""" 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. ;{i~/~ /0- ~(. 00 Date ----------------------------------------------------------------------------------------------- OFFICE USE Date of Application: Job#: Receipt #: Issued By: Amount Collected: