HomeMy WebLinkAboutPermit Signage 1994-10-07225 Fifth Street
Springfield, 0regon 97477
BANIVUR, BLIIIP, AND SEA.RCHLIGHT
SPI1CIAL PERM]:T
COMMUI'IITY SERVICES DIVISIOIi
sP. _..,,--FTELO
0ffice:
II.ISPECTION LINE:
7 26-37 53
7 26-37 69
Job Location:
Locat ion of Proposed Obj ec t :
Assessor Map #Tax Lot #
Ovner:
Address:Phone It:
Ci ty:State:ip:
Contractor/Ins taller
Address:I'lrone #
Ci ty:Sta te ztp:
Construction Contractors Regi.s tl--at j.on l'Juml-rer Exp i res :
Description
Date of Installation:
Speeial Permit Fee $40.0C Deposit Required $100.00
By signature, f state and agree that I have carefully completed this
and hereby certify that all information hereitr is true and correct.
agree and understand that the above described is not larger than 60
and vill be removed vithin ten (1.0) days fr.-on the date listed above.
above described is not removed '^'ithin the timeline specified, I vill
$100.00 deposit. f aLso understand that this special permit can be
once per calendar year per development area.
ate
applicationf further
sqLlare feet,
I f the
forfei t the
issued only
d
+r
10n :
OFFICE USE
Amount Co1lec ted :
7 -Q',q
Date o,f
Receipt
Appl- i c Job #:
Issued By: