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HomeMy WebLinkAboutPermit Signage 2007-8-23 (2) .-'. +-->- 'g! ~; f"\, ' ~, ~: 0:0; -. ' v-"i 7;"0'- ~/J.; <:V: ....--"-I rD. Q ~. ~---1 "", ~, ~. ............ ~' ~ ~l roe pqi , ' . n!;'YJ aNI ~[P~U'\<<i,D[lHJ])), Q))[R\G (LriG ))~ Co""," t.o07-0 IZS-S- 8,D13 ~mni.{l.;~. ~ 1703 Z'~lfL . G~~C'J~~~~:r:::-::Q..r.:> 22511ITH STREET . SPRINGI1ELD, OR 97477 . PH:(541)726-3753 . FAX: (54 1)726-3689 ~: ~ City Job Number "'\"""I 001 ."...., Job Location >, "~ AssessolS Mar' ~) OWller tv'), ew>: Q .,~, ~' ('j}I, W >.... COlltractor/lllst(lller. ~ -&,..,'" Contracto' r j h'1tlVll~ -V~ "El "....", ~ 0' Construction Contractors License # W ~) ,----"" IOD 1> ~Y\.1.hLLd (jlV Tax Lot 0 ((00 Owner of Property ~ J (I D Addrp". 10-50 ffi1V\ U-. P V ~ 1th f o I Cit Ut:.IVl{, State~- . jr Addr.... 'P t) P? ri :1;>0 City 01JiVv-::>.1 Lis Phon.. . ~ ,fY V"~/ D,/ "tate Of- ./ '54 /. ~ ~/P. 6~~o Z. q:lLlo I. III Zip 1&0, f-2..1~ q1 ?fX) PhonD ~~ ( Description ,,'In% h.'1.It] I'v-fj'I/....."ljYL\,UU V Date ofInstallation X', 2 ~ . 01-' Expir"" )Q ,23 ,01- ( z (o..,s~ Date of RemoVl Ge'mit}~ ~.o..,,, lUu'mling $100.00 Deposit. By signature, I state and agree that I have carefully completed this application and hereby certity that all information herein is true and correct. I further agree and understand that the above described banner(s) and/or portable sign(s) is not larger than 60 square feet, and will be removed within 30 days from the date listed above. If the banner(s) and/or portable sign is not removed within the timeline specified, I will forfeit the $IOO,()() deposit. I also undelStand 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 30th day to request an inspection to verity the removal of the banner(s) and/or portable sign(s), This inspection will begin the process to return the $IOO,()() deposit if the banner(s) and/or portable sign(s) has been removed, SignJ!tla;J;UX/rM&u Date of Application &/z~ft7 \-a' , Issued By For Office Use lob # C 7- biZ :s- ) Amount Collected Dat.. eJ), tltfJ (}q- Receipt # loto 'Z/J~ SbamI Drive (f:)'BuiI~ FccnsIBanncr]ortabk Sign Pumil CSD 8-06.doc