HomeMy WebLinkAboutPermit Signage 2014-5-20 SPRENCFtEL EY :'°`°°',
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225 FIFTH STREET • SPRINGFIELLD,OR 974770• FH:(541)726-3753 • FAX: (541)726-3689 4,:_ ` A `'''
gs . City Job Number S/ 7 —0 i I 01
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•, Assessors Map 703 3 3 S Tax Lot /1/ O Q
r' Business Name
C/pJ Business Contact Name Phone
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•. , Owner of Property M I ax-/1 IL (.L (-
Address 7 N 7 (4 sea-c -- V,. S Phone
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City et.&— State CNL Zip 9 71/4),.
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.,1■; Contractor/Installer 0 eAitre^t_
I Address Phone
City State Zip
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Construction Contractors License # Expires
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1l Description Co D(.5- co If 4.--C6- C/y— 7/ ia-..
Date of Installation Date of Removal
Permit Fe c di �P osit and applicable fees.
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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 individual banners and
F portable signs subject to this permit may not be larger than 60 square feet. I also agree and understand
.4"±':44 that temporary signs shall be removed within 30 days from the date listed above. If the temporary
sign(s) are not removed within the timeline specified, I will forfeit the$100.00 deposit. I also
understand that this special permit can only be issued four(4)times per calendar year per development
y area. I also agree to call the inspection line at (541)-726-3769 by the end of the 30th day to request an
i inspection to verify the removal of e tem•orI y sign(s). This inspection will begin the process to
C4a4 return the $100.00 deposit if the 1 •or. (s have been removed. 2
Q) Property Owner Signature Ii I tint Date �/
_ Fi�Office Use
3/0 _ 7,0 _ 58-76
(D; Date of Application n , / Job # 5/1 f_ 07/0 ( Receipt# Z0/11-0-0 /0 Fir
Issued By 1. . Amount Collected //:-
Shared Drive(T:YBmlding Forms/Temporary Sign Permit CSD 3-12 doc ,
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield.OR97477
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541-726-3753
' ...OREGON 811-SPR2014-01101 •
www.springfield-or.gov 136 S 6TH ST permitcenter @springfield-ar.gov
RECEIPT NO: 2014001095 RECORD NO: 811-5PR2014-01101 DATE:05/20/2014
/DESCRIPTION _ACCOUNT CODE/TRANS CODE _: , AMOUNT DUE
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
f_PAYM ENT TYPE - - - AMOUNT PAID
_____PAYOR,cnsNlER:oeowLSev COMMENTS__ - ;` ___,__ -_-.
Cash travis shafer 115.00
TOTAL PAID: 115.00
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