HomeMy WebLinkAboutPermit Signage 1997-2-5
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SPR.FIELD
DEVELOPMENT SERVICES DEPARTMENT
BANNER, BLIMP, AND SEARCHLIGHT
SPECIAL PERMIT
COMMUNITY SERVICES DIVISION
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726.3753
FAX (541) 726.3689
225 Fifth Street
Springfield, Orego~ 97477
Office:
INSPECTION LINE:
726-3753
726-3769
Job Location: \l1t\R)lA.J\JI'o.
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Assessors Map #: /'70 3 2.~
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Lot #: t4 '2... -c: "" I
Location of Proposed Object:."<")1 P,nN8=1<p~,,~,Av
Tax
Ololner: \lIe. l'/iAl\l(',
Address: 1'MJ7 l"lR"I'S= ~ 72.<12 S.W, Bv/UlS wA--I
Phone #: (SV?~ (0 It'-l-~'2.lD:L
City: WilSOl\lVlU.F'
'State:
f)(2...
Zip: "370,n
Contractor/Installer: i?rn=-rnp ~ /{)nl..\
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Address: -'~ nloo f(.;.:- ".
City: ~v=-"TI'>I'J
A-rrN: /)(AN~ <;7ANF:col\
(p~4 - 5"'?.~4 Gl':'T. 140
Phone #: 1(='2...... InC'~- - '2,<;"1 <j
State: t':I.2-
Zip: '1"')OOe"
Construction Contractors Registration Number:
Expires:
Description:
HD..,.. A.. R. \~A-L'-CO"""\ ,1200FTDP
S-, f2.211M l='/l..') A77.47G/-h...1?
7'0 no t1JT p:;
BJ (L-hl AlI___
Date of Installation:
)h:~/q1-
Special Permit Fee S40.00
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 arid understand that the above described is not larger than 60 square feet,
and loIill be removed ~ithin ten (10) days from the date listed above. If the
above described is not removed loIithin the timeline specified, I loIill 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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Signature
2/'5/o;q--
bate
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OFFICE USE
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Date of Application:
Receipt #: 24S'O?>
2-/ .rj5' ?
Issued By: '~~
Job #: 9 7ozz.1
Amount Collected: ~~Ch9
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