HomeMy WebLinkAboutPermit Signage 1998-02-10CITY OF SPRINGFIELD, OREGOAI
SPRIN .ELE,
D EV ELOP M ENT S ER W C ES DE PARTM E NT
225 Fifth Street
Springfield, Oregon 97 477
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541 ) 726-3753
FAX(541) 726-3689
BLIMP, SPINNER, PENNANT, BALLOON, SEARCHLIGHT PERMIT
COMMUNITY SERYICES DryISION
Office: 726-3753
INSPECTION LINE: 726-37 69
Location 4
Assessors Map #:
Owner of Property:
Tax Lot 2'
Lnnr'ro l/vt orse
City:
+l-
Phone #' 7///- ?2A ZAddress:
City:State:Zipz a2/rn
Contractor/Installer:
Address:Phone #:
State:zip
Construction Contractors Registration Number:Expires
Description: l3a n ne R
Dateof Installation: Z- I l-7v Dateof Removal: 7 ^ Z l-7&
Permit 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 display will be
removed within ten (10) days from the date listed as the date of installation above. If the display is not removed
within the timeline 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 at126-3769 by the
end of the 1Oth day to request an inspection to veriff the removal of the display. This inspection will begin the
process to return the $100.00 deposit if the display has been removed.
7-/o-#
Date
OFFICE USE
Date of Application Receipt #:
Issued By:
Job #:
Amount Collected:ao
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