HomeMy WebLinkAboutPermit Signage 1996-6-17
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SPRI:'ELD -- -"
DE !'[LOP,. ![tIT SERVICES DEPARTMENT
BANNER, BLIMP, AND SEP~CHLIGHT
SPECIAL PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726,3753
FAX (541) 726,3689
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3753
726-3769
"
Job Location: ?Af\ \J...n ~f\ ~J\oot
Location of Proposed Object\,~ l.~ \r\.., f'i'\ *,
Assessors Map #:~-m..~ Ta,: Lot #: \~rl()
o"ner:u~M\ \,\1111\ ~7\Qrf'o ~ t\()J> rlf-J
Address: ~~J1'o'Lf'\. . Phone #: \2.-\0 ~l\qct
CitY:~0\~oQn State: a~~iP: Ol417
Contractor/Installer: ~ ."')(\0 12-)
Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration Number:
Expires:
DeSCriPtion:\.~f\ \\C\ ((~~ \_~YO)r\ 5
Date of Installation: _\O.~\. Cl....\.o
" Special Permi t 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 "ill be removed "ithin ten (10) days from the date listed above. If the
above described is not removed "ithin the timeline specified, I "ill forfeit the
$100.00 deposit. I also understand that this special permit can be issued only
once ~ calendar year per development area.
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Date '
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OFFICE USE
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Date of
Application:
#: J8~~
lQ.'R.q(o
Issued By: f1t iJCL/
Job #: QioQgl<6 ">
Amount Collected: _~~.~
Receipt