HomeMy WebLinkAboutPermit Signage 2001-07-27CITY OF SPF'A'GFIELD, OREGON
DEV ELO P M ENT SERVI C ES D E PA RTM ENT
225 Fifth Street
Springfield, Oregon 91 47 7
BAI\I\TERPERMIT
COMMUNITY SERVICES DTVISION
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
Office: 726-3753
INSPECTION LII{E:'l 26-37 69
Assessors Map #:l).o3.2€'3/Tax Lot 0 -tl o-o
Owner of Property:$f\( Kc"-\J:l
Address
City:
Phone #:
eR-zip:.?;40-t-State:
Contractor/Inst aller :
Address: {ffi-,a- R-? C '--T-o-,-^ \q,.-Phone #:5-J
City:L
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Constmction Contractors Registration Number:
State: (^r G{Zipz 9t YoS
Expires:
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Description:-Ba" Nr\ \c\ € xl'-
Date of Installation:8-lo-o1 Date of Removal: a- Zq -O
Banner Permit tr'ee $80.00 Deposit Required $100.00
By signature, I state and agree that I have carefi:Ily completed this application and hereby certi$ that all
information herein is tme and correct. I further agtee and understand that the above described banner (s) is not
larger than 60 square feeq and will be removed within 14 days from the date listed above. If the banner(s)
is not removed within the timeline specifieq I will forfeil the $100.00 deposit. I also understand that this special
permit can be issued only trrice per calendar year pff development area. I also agree to call the inspection line at
726-3769 by the end of the 14th day to request an inspection to veri$ the removal of the barurer(s). This
inspection will begin the process to return the $100.00 deposit if the banner(s) has been removed.
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OFFICE USE
Dateof Applicanon: 7- &? -o t ,"6s' 0f- 0D 19r{-OlReceipt #: drnvGL-| 7
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