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HomeMy WebLinkAboutPermit Signage 2014-6-2 • SSPRFNEGe^EEL6 U'.T,c_.;.'i. • xk-dFT-r te' ! t" ffi�' i ..w.�wevira�C s 3 �. �..� . �-- CIeTY FrSPRI_ 6FTFLD, ®R- G4- on _ � $ --_ ��----11 225 FIFTH STREET • SPRINGFIELD,OR 97477+7 • FH:(541)726-3753 • FAX: (541)726-3689 _.,,,y W ,k',.��',..:a. '`.' t-: City Job Number S7y"—C 11 / O s '< Job Location L1 A6 qA i' J cC cni ., Assessors Map Tax Lot f Business Name 00k-I 4ck Au\o&to4-ice C-LC c t Business Contact Name 3.-0 h--I p0 Phone •S-2/ / 'g9 084/ •••—•4 Owner of Property p or✓ r f^,,se,t„. , !t--(t-Ot7 iQ u.e. t, , , /46,r/ Phone V(-7c/7- S2oc” i City 3,1e ci State p Zip 9 7-4/ 77 r--�- , (,M Contractor/Installer f7Z2 a Address 4 l36 Mel S't– Phone .54,l 6S4 ©gci/ City SprI ",c(k State Q(Z 'Zip C( 7 7g - �; Construction Contractors License # Expires rrrrO�,�� r II Description S 11" 4 Date of Installation ' " r l 2cg 201C, Date of Removal Sot as oui(c ^_ Permit Fee: $225.00 including $100.00 Deposit and applicable fees. 1 P-- i By signature,I state and agree that I have carefully completed this application and hereby certify that c all information herein is true and correct. I further agree and understand that individual banners and '('(` portable signs subject to this permit may not be larger than 60 square feet. I also agree and understand „,�1 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 a area. I also agree to call the inspection line at (541)-726-3769 by the end of the 30th day to request an inspection to verify the removal of the temporary sign(s). This inspection will begin the process to --1 return the $100.00 deposit if the -mporary sign(s) have been removed. Q Property.Owner Signature (-- 10, S Date s/j/�/v {" For Office Use /1 L r ' Date of Application 6l G/�y Job# S/7'6/1 7 " Receipt# Q} [=•a, �— 2 Z S Issued By .---�X Amount Collected Shared Rive(T:)/Building Forms/Temporary Sign Permit CSD 3-12.doc SPRINGFIELD'--. CITY OF SPRINGFIELD .;.��.,.,,, 225 Fifth St . TRANSACTION RECEIPT Spdngfield,OR97477 OREGON 541-725-3753 811-SPR2014-01196 www.spdngfield-or.gov 4136 MAIN ST permitcenter @springfield-or.gov RECEIPT NO: 2014001205 RECORD NO:811-SPR2014-01196 DATE:06/02/2014 PION 'a?`' lkO nllr,"#,..+`Sin'!:t k:NIk*s "trACCOUNT CODE/TRANS CODE=L'il`i iNAMOUNTIDUE"k"_9 Admin fee(10%of applicable fees) 224-00000-426605 1098 . 20.00 Banner, Portable 224-00000-425602 1065 100.00 Banner, Portable Deposit 821-00000-215500 1049 100.00 Technology fee(5%of permit total) 100-00000-425605 2099 5.00 i��, TOTAL DUE: 225.00 L PAYMENT;rIPE �PAYOR Cri DISDir eY MOUNT/PAID Check outback auto repair Ilc refund to: 225.00 1103 outback auto repair Ilc 4136 main st springfield, or 97478 TOTAL PAID: 225.00 • • •