HomeMy WebLinkAboutPermit Signage 1999-9-24
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225 F/FTH STREET
SPRINGFIELD, OR 97477
(541) 726,3753
FAX (541) 726-3689
BANNER PERMIT
COMMUNITY SERVICES DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
Banner Location: I q oc::. '1>: O~ '?a..... k....u~ fA-- S t-
Assessors Map #:
II 03 ClL.:;'''''
Owner of Property: \-00 ~ <Y'-~
Address:
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'S . W. <<"'LA. <;, L. ...... d"'7 0
Phone#: 503 - ("3(,, - t/ObJ.-
City: oI-A IL<.. c>.:,.........., "'Q'>
ContractJ)U;lIA~: 1 D N\ 11 ,r " S<>-^-
THIS PERMITSHALLEXPIRE hHEWORK
Address: !\UTIIOm~I:[; u;,jiJOiTnl;:) t"t:HIVIIII::i NOT
City: COMMENCED OR IS ABANDONFn FnJ:l
ANY 180 DAY PERIOD.
Construction Contractors Registration Number:
Description:
"2>10.- Y"\ ""- a.~
Date ofInstallation: q -1>-1 - q <1
Banner Permit Fee S40,OO
Tax Lot Q:).1J7J 0
State:
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Zip:
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State:~ H;1~-d~'. .~~C11 ( :'YOlZippAh 0tJ2-U01..
JO!'lU YOI .118'.' Q':l181r. COPI€)o Ollf), ,UltI<> U~
call1n( :m 68n~(Expir.if' tP~ t,;'t.ptlone
numbe1lor lh< O:-e;:>Cn Utlllly i~Ollll(;i:1l1UII
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Date of Removal: 10 - <6 _ Cj 01
Deposit Required SIOO.OO
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 banner (s) is not
larger than 60 square feet, and will be removed within 14 days from the date listed above. If the banner(s)
is not removed within the time line specified, I will forfeit the $100.00 deposit. I also understand that this special
permit can be issued only twice per calendar year per development area. I also agree to call the inspection line at
726-3769 by the end of the 14th day to request an inspection to verify the removal of the banner(s). This inspection
will begin the process to return the SIOO.OO deposit if the banner(s) has been removed.
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ate
Date of Application: q -d.4-C, "\
Issued By: Cf><( <.<. .)
OFFICE USE
Job #: CJOr' 0 q C) '7 Receipt #: f) ::j<; & 7Jf
Amount Collected: .$ (Ii-() .