HomeMy WebLinkAboutPermit Signage 2013-11-13 SPRINGFIELD
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225 FIFTH STREET • SPRINGFIELD,OR 97477 • PH:(541)726-3753 • FAX: (541)726-8689 OREGON
c1 FIREWORKS SALES LOT/CHRISTMAS TREE LOT Banner/Portable Sign Permit
BUSINESS INFORMATION
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PROPERTY OWNER'S INFORMATION'
*Property Owner's Name: *Property Owner's Contact#:
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t•—'i,'.. *Property owner's Address where sale is to be conducted:
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o -, CONTRACT/INSTALLER INFORMATION - -
CA Contractor's Name Full Name Phone#:
601 s coc.W 67 (5d/ ) 232-350`1
Residence Addr s(No P.O.Bos
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0 Mailing Address if different from above: a Enm11/Address:
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Construction Contractors License#: Expires:
_ ADDITIONAL INFORMATION '
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iza Date of Installation Date of Removal
VAC)u, 1013 N I 2-0/ 4
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0 PERMIT' FEE: $115.00
SIGNATURE AND INFORMATION
By signature,I state and agree that I have carefully completed this application and hereby certify that all
information herein is true and correct. I further agree and understand that the above described banner(s)and/or
portable sign(s) is not larger than 60 square feet.
Applicant's Name(Please Print) Applicant's Signature
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Date Applir ion .lob# Receipt ti Issued By: Amount Received:
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SPRINGFIELD -- CITY OF SPRINGFIELD
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• s .- 225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
OREGON 541-726-3753
811-SPR2013-02501
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www.springfieldor.gov 4490 MAIN ST permitcenter @ springfield-or.gov
RECEIPT NO: 2013002495 RECORD NO:811-SPR2013-02501 DATE:11/13/2013
xDESCRIPTION - ACCOUNT CODEYTRAN$;CODE ' ;.' AMOUNT DUE J
Admin fee(10%of applicable fees) 224-00000-426605 1098 10.00
Banner, Portable 224-00000-425602 1065 100.00
Technology fee(5%of permit total) 100-00000-425605 2099 5.00
TOTAL DUE: 115.00
PAYMENT TYPE" PAYOR CASHIER:DBOWLSBv,--,, _!` - -COMMENTS -. .. AMOUNT PAID .
Check maria spangler 115.00
2338
TOTAL PAID: 115.00
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