HomeMy WebLinkAboutPermit Signage 1998-7-30
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DEVELOPMENT SERVICES DEPARTMENT
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
BANNER PERMIT
COMMUNITY SERVICES DIVISION
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Owner of Property: A) ~YL P () <:..,...Q. \J
Address: q 3~ 9 tJ' &/ \,
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Conlractorllnstaller: /) \1 ) '/\..LA-
225 Fifth Streel
Springfield, Oregon 97477
Banner Localion:
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Assessors Map #:
City:
Add ress:
City:
Construction Contractors Regislration Number:
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Office: 726-3753
INSPECTION LINE: 726-3769
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:J, 7_ () ::::.u u () Tax Lot
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Stale:
Phone#: 7 L OJ 3<g U
07 ~7 'Z
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Zip:
Phone #:
Slale:
Zip:
Expires:
Description: ~e..WA-s~ ~ ~(?Q V;r'\U 104 /u.;,h '{ 3,(-l-
Date of Installalion: l - "3 } - CJ "'X Date of Removal: '7f - '2.. ~ c:; C;;
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Banner Permil Fee $40.00
Deposit Required $100.00
By signature, I slale 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 nol
larger than 60 square feel, 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 SI 00.00 deposit. I also understand that this special
pennil 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 inspeclion
will begin the process to return the SIOO.OO deposit if the banner(s) has been removed.
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Date of Application: 7- '30 - q <t
ATTENTION:Oregon law requ!r~s you. ~o
follow rules a_~ the ori!'Q.Qll W\lhty
Notification Center. Those rules are set !onn
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the tel~~ho~e
number for the Oregon Utility Notification
, Center is 1-800-332-2344).
OFFICE USE
Job#: qX- OQS2 Receipt#:
Amount Collected: $.1<iO . -
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 1."0 Of, V PERIOD.