HomeMy WebLinkAboutPermit Signage 1994-5-28
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SPRINGFIELD
BANNER, BLIMP, AND SEARCHLIGHT
SPECIAL PERMIT
COMMUNITY SERVICES DIVISION
,
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3753
726-3769
Job Location:
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Location of Proposed Object:(':J-l\B~ ffi~
Assessors 1ap #:~ro::3 4Q.._ Tax Lot #: rf14Jl>
Owner: \Y\.~CX\ L 5\u:*-O
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City: \.~~ State: ~ZiP: 9JfJB
Contractor/Installer:
Address:
I'hone #:
Construction Contractors Registration
State: ~ ,,,, ~ Zip:
Number: ___~Expires:
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Description: ~~ ~Jl..()(),,'3,
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Date of Installation:
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 ar~a.
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lJ~ture ' ~ Dare
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, OFFICE USE
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Receipt #: \~ Issued By: ~()_ ~ount Collected: /40.00