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HomeMy WebLinkAboutPermit Signage 1999-1-7 . 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: ~(J7) (Yl~ s.u::u. t? Assessors Map #: \I O~ 310 41 ?o.k. -KrlAo) _ W -2.., +r. U Tax LoI no'~ ~ Owner of Property: Address: c:ll 8 .,,- Cily: h,.u-..., - U - ConlractorlInstaller: Phone #: Slate: De- Zip: q 71-{1lS- D~( ~~'S.\ Address: Phone #: Cily: Slate: Zip: Conslruclion Conlractors Registration Number: Expires: Description: d2~ Dale ofInslallalion: \ ~ 1 ~ 'i''''I Dale of Removal: \-~-q,,\ Banner Permil Fee $40.00 Deposit Required $100.00 By signalure, I slale 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 banner (s) is not larger than 60 square feet, and will be removed within ten (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 that this special permit 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 14th day to request an inspection to verifY the removal of the banner(s). This inspection J. will b,e/j g~. proro7cess t return the $10 00 deposit if the banner(s) has been removed, {'". [~ ~ )(~r!,y1l9' ~ ~ Ioate ------------------------------------------------------.- , Date of Application: OFFICE USE Job #: q (;( iSl / Receipt #: '3JJ-f~ .AmountCollected:~h, - \-1-"\ '1 -\<M.> ..,. RtI\WJu..-t - ~ ~ .6J:.tlL 6-'>'- A.~ Ot, 1'.1^- U u. Issued By: