HomeMy WebLinkAboutPermit Signage 1999-12-16 (2)
.
DEVELOPMENT SERVICES DEPARTMENT
BANNER PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726,3753
FAX (541) 726,3689
225 Fifth Slreel
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Banner Location:
'fn:J 11Q./k Si",eT
nO J. ~ d- y;P d-<SCrV
Tax Lot
~
Assessors Map #:
Owner of Property: .::r;;cj~.;. fl~ 1<0)( L ('.
Address: <t- Sb (j . <; /AI icY' ~I"_ iVaI
City: Lite.. OSto./::1""
Contractor/Installer: L e./t",r ~ ,{(Jro c".<f~.., f;" h
State:
or<
Phone #:~03) (' .3 6 - Y- S' 6 S-
Zip: <f?o f,)
#=270
Address:
~81f8q ShilL.."
I
.).or! -ci-((' Ie!
tI oj
(0
Phone #:
Description:
1Ie>-e. {;..;e..,.
State: {) (\
]27.Lf-J
~""'e- ~ :::J:..<-k it.. +l..Q
Zip: q 71./78
City:
Construction Contractors Registration Numher:
Expires:
tCJ ><
Date of Installati~..- -T.4LL '~/;, ,/:) aCf5
D fR I/' JfI.-. i. '.'" ,..c;l.':.'@O.".....().,
ate 0 emova:-' =~_,_. !,!,,_
I
Banner Permit Fee $40.00
Deposit Required $100.00
By signature, I state and agree that I have carefully completed lhis application and hereby certify lhal all
infonnalion herein is lme and correct. I further agree and undersland lhal the 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 the limeline specified, I will forfeillhe $100.00 deposit. I also undersland thallhis special
penn it can be issued only lwiee per ealendar year per development area. I also agree 10 call lhe inspeclion line at
726-3769 by lhe end oflhe 141h day 10 request an inspeclion 10 verify lhe removal of the banner(s). This inspection
will begin the process 10 relurn lhe $100.00 deposit iflhe banner(s) has been removed.
~arure &JJ?:d
< J2-/6- 7'9
<-"ate
----------------------------_._--------.------------------------------------------.------------------------------------.----------------_.-
OFFICE USE
Dale of Application: IA - llo - C; q
~
Job#:
GtCJ I d,'t L-(
Reeeipt #:
Issued By:
Amount Collected: $li-D .
-