Loading...
HomeMy WebLinkAboutPermit Signage 1998-1-30 . DEVELOPMENT SERVICES DEPARTMENT BANNER PERMIT COMMUNITY SERVICES DIVISION 225 Fiftb Street Springfield, Oregon 97477 Banner Location:,p.-k 1; b.1. :y:) /14-"" (If) k Assessors Map #: /7fJ pc;' /~() Qw..."_",,, l?l f R 1"Y ^ (, Address: .2/.3D Mff'lf"l'I/er j;d' City: S OJ" ~ /I c:; f' ~ t? ..Y / / d ..p Contractor/lnstaller: /-/ a r r ~ /J , Address:2 (> c../ Jo_((t?/S'oVl City:t::A~O_ R construc<<':: Contr~ctors Registration Number: Description: F/'~ ~ Date ofInstallation: )-.1>0':7'j)" State: /'l/r &r",C'" ~~s State:/jlf ~~d Date of Removal: Banner Permit Fee $40.00 225 FIFTH STREET SPRINGFIE~D. OR 97477 (541) 726.3753 FAX (541) 726.3689 Office: 726-3753 INSPECTION LINE: 726-3769 T..... 9~O ~ ,f"f) Pbone#:JiiYJ - .< 3/, ~.s;:s Zip: ,97<;1 - // Phone #:3Cf~ -I')" '7 Zip: 9'/ cj t);:Z Expires: /0- J - /' y- W ;<.-4/-7 V Deposit Required $100.00 By signature, I state and agree that I have carefully completed this application and bereby certify that all infonnation 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 penn it 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 14th day to request an inspection to verify the removal of the banner(s), This inspection will begin the process to ~ m the $100.00 deposit if the banoer(s) has been removed.. /" ~_ /--.JO-72{ Date en 10(d) ReceiPt#:rV'6u'70 Amount Collected: \4 D ~ Date of AtPIi~tion: 1- '-~() - q?{ Issued By:C\ 1_ ["(\ :; OFFICE USE Job#: