HomeMy WebLinkAboutPermit Signage 1998-1-30
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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;' /~()
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Address: .2/.3D Mff'lf"l'I/er j;d'
City: S OJ" ~ /I c:; f' ~ t? ..Y
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Contractor/lnstaller: /-/ a r r ~ /J
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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
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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
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Zip: ,97<;1 - //
Phone #:3Cf~ -I')" '7
Zip: 9'/ cj t);:Z
Expires: /0- J - /' y-
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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.. /"
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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#: