HomeMy WebLinkAboutPermit Signage 1999-05-28CITY OF OREGO'U
SPFlINGFIELEl
D EVELOP M ENT S ERWCES DE PARTME NT
225 Fifth Street
Springfi eld, Oregon 97 47 7
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541 ) 726-3753
FAX(541) 726-368eBANNER PERMIT
COMMUNITY SERVICES DIVISION
Office: 726-3753
INSPECTION L[NE: 726-37 69
Banner Location: ll I A S+,-
Assessors Map #: 11 o G 3l o Tax Lot 0 "l
Phone #:7 q6-sr1 1
Owner of Property:
Address:11 8L t4 \+-
City:SAx State:M zip, q 7VT 7
City:
Construction Contractors Registration Number:
Description:i-rz- bo.nvrerr
l, " I ,?o7
Contractorflnstaller:
Address:tq{ N a{t *Phone#: 7qt-A r0t
zip aT{tY
Expires
Date
State:
Date of Installation:Date of Z
v Banner Permit Fee $40.00 Deposit Required 00.00
By signature, I state and agree that I have carefully completed this application and hereby certiff that all
information herein is true and correct. I further agree and understand that the above described banner (s) is not
larger than 60 square feet, and will be removed within ten (14) days from the date listed above. If the banner(s)
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 twice per calendar year per development area. I also agree to call the inspection line at
726-3769 by the end of the l4th day to request an inspection to veriff the removal of the banner(s). This inspection
will begin the process to return the $100.00 deposit if the banne(s) has been removed.
(--n,ilua /&q/-
Signature
2o 2
OFFICE USE
Job #:4)4"Date of Application:
Issued By
Receipt #
Amount Collected:
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