HomeMy WebLinkAboutPermit Signage 1997-5-12
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SPRttFIELD
BANNER, BLIMP, AND SEARCHLIGHT
SPECIAL PERMIT
COMMUNITY SERVICES DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office:
INSPECTION LINE:
726-3753
726-3769
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Assessors Map #: \\(f)~<;:1?l\ Tax Lot #: [)llOO
O"ner: ~(\,J- ~.f') 5\N'
Address:_~ ~~-" ~J- ;;:ne #: ~~\.~\tO
City: ~\.O{'(\ State: llitDDY\ Zip: ~l?{)\
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lr\ ~ l'hone #: L\:~<; .~'h~\O
State: (OMC\(f\_ Zip: Q14ffL-
Registration Number: ~~ires:&.\.o.i
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Construction Co~tractors
Contractor/Installer:
Address: \~\D (
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 "ill be removed "ithin ten (10) days from the date listed above. If the
above described i~ not removed "ithin the timeline specified, I "ill forfeit the
$100.00 deposit. I also understand that this special permit can be issued only
one er calendar year per development area. I
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.5//zJ!L7
Date'
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OFFICE USE
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Receipt #: ~Issued By: ~_) Amount Collected: \4l\90