HomeMy WebLinkAboutPermit Signage 1998-12-24
.
BANNER PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STREff
SPRINGFIELD, OR 97477
(541) 726.3753
FAX (541) 726.3689
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Banner Localion:
'2..4.00 (lfJDJ ST .5;, h. c:
I
S P20' ')J, he I J ()f.. "f1 ,-/7 .,
Assessors Map #: 11 0 ~ 3 l_ '4- I
Owner of Property: ~'(ljt I'\" LV I
Address: ZIli'S' W 7..P,P. /lt/p
Tax LoI 0 0 I O'll
Phone #:
Cily: E",,,, ""-''''
Slate:
~ Zip:
~:::)
"17400-
ConlraclorlInslaller:
Cily:
Slale:
Zip:
~
Address:
Conslruclion Conlraclors Registralion Number:
Descriplion: 9 A 'o(\n t\ Q ~ 5
Expires:
Dale of Inslallalion:
1'2-/ZtJ 1"11
Dale of Removal:
(!7(/01/""Q
Banner Permil Fee $40.00
Deposil Required $100.00
By signalure, I stale and agree that I have carefully completed this application and hereby certify that all
infonnalion 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 dale 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
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 14th day to request an inspection to verify the removal of the banner(s). This inspection
Wi~~_O deposit if the banner(s) has been removed.
- I '2-/'2-'-J /0,9
BlgnatiIre Date
------------------------------------------------------------------------------------------------------------------------.
Date of APPli~ \n.~ .G\$(
Issued By: ('J )lOO~ )
OFFICE USE (\ ,
Job#: ~ <6\~ ReceiPt#:P->~3q5
Amount Collected: 1_u.gJ
.