HomeMy WebLinkAboutPermit Signage 1999-9-24
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BANNER PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Banner Location: -6;, ~
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Assessors Map #: } 7 () ;).. '3 d tf d-
Owner of Property: ~.P f' /1, ~OY\
Address: -1 '1 4 0 m olvv S::f::,
City: S~th;~
contractor~nstaller: () ~ ( t!---WYtt.- ~
Address:
Tax Lot
00 ID I'"
q741f
Phone #:
State:~u
Zip:
Phone #:
City:
State:
Zip:
Construction Contractors Registration Number:
Description: 4 'f ~
Date oflnstallation?1- 2/n - q C1
Expires:
Date of Removal: 10 - I () - q 9
Banner Permit Fce $40.00
Deposit Required $100.00
By signature, I state and agree that I have carefully completed this application and hereby 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 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 thatthis 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 14 0 request an inspection to verify the removal of the banner(s), This inspection
will begin the process to r urn the $10 ,00 deposit if the banner(s) has been removed,
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Date
OFFICE USE
Issued By:
Cf-';zI- 7"'1
c:KttJ
Job #:
01/;) 3<6
Receipt #: ,3S" 7::J-.
Date of Application:
Amount Collected:.Mo, -