HomeMy WebLinkAboutPermit Signage 1999-11-29 (2)
BANNER PERMIT '
COMMUNITY SERVICES DIVISION
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
225 Fifth Street
Springfield, Oregon 97477.
Office: 726-3753
INSPECTION LINE: 726-3769
Banner Location: /)(_,_t.. c-S;,(".,( 0 ('L,u.J( 1/1/1 rl
Assessors Map #: J -:J-O,- ~QlQ;2Lj,-()'1250,3
Owner of Prope'rty: !1 )l)(~~~) U).<<')+ / \ . 'it ./
Address: .5 j l/' Q ,~,.I-,
City:~:rr\-n.tJ.-p i ni
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Contractor/Install: Ow ~
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- Tax Lot (1-
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Phone #:.Jjj - :;- 2/ & -/3 fS7 0
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State:
Address:
Phone #:
City:
State:
Zip:
Construction Contractors Registration Number:
Expires:
D~scription:
Banner Permit Fee $40.00
Date ofRemoval:DfLQ... l ~ ~ \., S c;
Deposit Required $100.00
Date of Installation: ~;).. \ ~ 9. 9
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 timeline 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 $100.00 deposit if the banner(s) has been removed.
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, Signature l -r 0;;;;]
-------------------------------------------------------------------------..----....---..---------....--------------------------------------------
, . ,
Date of Application:
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9'<\~
OFFICE USE'
Job #: q 0; J 0 , ~eceipt #:
Amount Collected: dP \lJ-O .
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Issued By: