HomeMy WebLinkAboutPermit Signage 1994-3-8
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BANNER, BLIMP, N'D SEARCHLIGHT
SPECIAL PERMIT
COMMUNITY SERVICES DIVISION
225 Fifth Street
Springfield, Oregon 97477
Office: 726-3753
INSPECTION LINE: 726-3769
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Assessors Map 1I: 10Cl~QLoQ ~ Tax Lot #: OIQm
Owner: \ )\c}~\fLfl~ .
Address:f)f6Q. 89.)2Jh..wo~s
City: LA ~\ \ 3:D\ ")J) Q Qj
Contractor/Installer: \ J~ 1 Jfl.2e ~
Phone #: L&3Q /C/1Jr;?
State: (<::+e- Zip: ~O
Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration Number:
Expires:
Description~.
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Date of Installation:
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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 h~rein .is true and correct. I further
agree and understand that the above described is not larger than 60 square feet,
and will be removed within ten (10) days from the date listed above. If the
above described is not removed within the timeline specified, I will forfeit the
$100.00 deposit. I also understand that this special permit can be issued only
once per calendar year per development area.
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OFFICE USE
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Date of Application:
Receipt #: 11i3....1..'::s
c~.f)3t ) Job #: Q4()Qq I
Issued By~U:'0~.ount Collected: /4r}OO