HomeMy WebLinkAboutPermit Signage 1995-11-7
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BANNER, BLIMP, AND SEARCHLIGHT
SPECIAL PERMIT
COMMUNITY SERVICES DIVISION
*
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Job Location:
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Address:
Location of Proposed Object:
Assessors Map #: 1707,~=3c.1c{ OO'iS'-OLot #:
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Phone #:
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Zip: Qi'17(
Owner:
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State:
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Contractor/Installer:
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Phone #:
Address:
City:
State:
Zip:
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Construction Contractors Registration Number:
Expires:
Description:
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Date of Installation:
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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
once per calendar year per development area,
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OFFICE USE
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Date of
Application: /!~ 7- 1'r
#: NS-.22-Issued By: r/[}
Amount
Receipt
Job #: 957 7 t:. f-/
Collected: tiI/tft:J -dr)