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HomeMy WebLinkAboutPermit Signage 1999-9-24 .... . 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;, ~ . , 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, ;:;{ L"AJ) ~re 9/ cJ,4- 7(( 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, -