HomeMy WebLinkAboutPermit Signage 1999-12-16
.
DEVELOPMENT SERVICES DEPARTMENT
BANNER PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STRE
SPRINGFIELD, OR 97.
(541) 726,3i
FAX (541) 726,3<
225 Fifth Streel
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
'-..
!
i
"
.;,1
.','4
Banner Location: It 17 S- 11Q./ k. Sf,.,eT
Assessors Map #: h D L :, '2- ~?-b ~..... () V
Owner of Property: J4 c-k ,'. fl~ 1<0)( I,.r
Address: YSD~~v./ k:-tf"y_rf'. tV? ih.70
[q,te.. OSwe._ Or<
City: State:
. Tax Lot
~
":.1
~
Phone #:~03) .(.56 - l;-,)f"S-
Zip: 770/ ,C;-
,"_".i
";;";
Contractor/Installer: L (.11...,- 1- .>011 C;~.tf,.", 1,'0 k
Address:
&'8lfgq SfeIlL""
.C)l)r Lfu IJ
tJ 'J
r<.J
Phone #:
I
Description:
fle.r-e. Vve..
State: 0 f\
]22.'1-)
(;,,,., e. - .:::J:.cj(, it-, +le
Zip: q 7'j-78
City:
Construction Contractors Registration Number:
Expircs:
tCJX
Date ofInstallation: /l,,-<- ) 7 f 99 <i
Date ofRemoval:~ _ -?, I
1<10"'1
Banner Permil Fee S40.00
Deposit Required SIOO.OO
. ,
By signature, I state and agree lhat I have carefully compleled this application and hereby certify that all
information herein is true and correct. I further agree and understand thallhe above described banner (s) is not
larger than 60 square feel, and will be removed within 14 days from lhe date listed above. If the banner(s)
is nol removed within lhe timeline specified, I will forfeit the $ I 00.00 deposit. 1 also understand lhallhis special
permil can be issued only twice per calendar year per development area. I also agree to call1he inspection line at
726-3769 by the end of the 141h day to request an inspection 10 verify the removal ofthe banner(s). This inspection
will begin lhe process 10 return the SIOO.OO deposit iflhe banner(s) has been removed.
~gnarure (ZAt
.( /'2 -16 - 79
'Date
:;'1
----------.--------------------------------------------------------------------------------------------------------------------------------
Dale of Applicalion: 1;). _ I <n -
~
C1Q
OFFICE USE
Job #:,.gs I ;('1>' U_ Reeeipl #:
Amount Collected: Jt.[ U-O ,-
Issued By: