HomeMy WebLinkAboutPermit Signage 1995-10-12
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BANNER, BLIMP, AND SEARCHLIGHT
SPECIAL PERMIT
COMMm,ITY SERVICES DIVISION
225 .Fifth Street
Springfield, Oregon 97477
, Office:
INSPECTION LINE:
726-3753
726-3769
-
Job Location: !:S ~~ '\'\'<\.ili ~\H) r ~
Location of Proposed Object:~.{Qf\~h~.~chnQ .,~...'
Assessors Map 1I: . 1100~';A _Tax Lot 1I: ffi?fX'') . ~
owner~-mtl9.~~) .
Address: _ ~ '- <<l ffin Lf'.. Phone 1I: ~. 2J loS r)
City: q.tlfL., . state:jlQ.{U Zip: 92tl~
contractor/Installer~1 _'~
Address: Phone 1I:
Ci ty:
State:
Zip:
Construction Contractors Registration Number:
Expires:
DeSCriPtion:~f\~f~ ~ \_~\r:oY\
Date of Installation:
H).\~.q~
Special 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 is not larger than 60 square feet,
and will be removed within ten (10) days from the date listed above. If the
above described 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
'";!~:::;i: '" ':'Z: "'" 10 I ~~
Si~ature .-J' ~ Date! '
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OFFICE USE
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Job 1I: qD\ld\~
~ount Collected: ~,()C)
APP~}la~l7\
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Is~ued BY~ ~
Date of
Receipt