HomeMy WebLinkAboutPermit Signage 1995-10-30CITY OF OFEGO'V
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BANIVER, BLIMP, AND SEARCHLIGHT
SPIiCIAL PERM].7
COMMUI{ITY SEI{VICES DIVISIOI']
SPFTINGFIELE,
0ffi ce:
II.ISPECT]ON LINE:
7 2.6-37 53
7 26-37 69
225 Yifth Street
Springfield, Oregon 97477
Job Location:
Location of Proposed Object
Assessors ap #:q
Ovner
Add res s
Ci ty:
Con t rac t orlIns t aI ler :
Address:
Lot #:
Phone
State:Zipz
l'hone *:
Ci ty:
Construction Contractors Regis lration I'Jumber :
State Zipt
Exp i res :
Description:A8..Rn\\rN-\
Date of Installation:
Special Permit Fee $40.00 Deposit Reqr,rired $100. 00
By slgnatLrre, f state and agree that I have carefully cornpleted this application
and lrereby certify that a1l- information hereit'r is true and correct. I further
agree and understand that the above described is not larger than 60 sqtlare feet,
and vilt be removed within ten (10) days fr-om the date listed above. If tlte
above described is not removed vithin the timeline specified, I vi11 forfeit the
$100.00 deposit. f also understand that this special permit can be issued only
once per calendar Year r development arr?a.
Date
5
2
A
Date o_f App
Receipt #:
n Job #:licat
Issued By
OFFICE USE
mount Collected:
7