HomeMy WebLinkAboutPermit Signage 2014-08-12225 FIFPH STREET o SPRINGFIELD,OR 97477 > PH:(541)726-3753 • FAX: (541)726-3659
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City Job Number `1W,1014
Job Location
Assessors Map 17- 6 3 - Z7 S 1610 ,5—L�I ax Lot
BustnessName e511 -J14 ,'J
Business Contact Name Phone `.) Lrt - cy/C� - 000
Owner of Property /i/i)`/ .So uvr/t
Address /J el l'I'las t ✓ Phone e --)q
City ---V, (, if �, stateZip
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Contractor/Instatter ZI44- 5_ n
Address 13M `71"kkk, `— 1.3I11D Phone 564A/'r%/c/_OYO(
City /l State (% Zip 77 V77
Construction Contractors License # /v t 7 Expires _
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Date of Installation / 3 1 Date of Removal,
Permit Fee: $225.00 including $100.00 Deposit and
fees.
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
portable signs subject to this permit may not be larger than 60 square feet. I also agree and understand
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
area. I also agree to call the inspection line at (541)-726-3769 by the end of the 304' day to request an
inspection to verify the removal of the t porary sign(s). This inspection will begin the process to
return the $100.00 deposit if the tympApfy sign(s) I�aye been removed.
Property Owner Signature
Date of
Issued By
Date
For Office Use
Job #
Receipt #
Amount Collected
Shared Drive (T:)Bmldi g Forms.?emporuy Sign Permit CSD 3-1Um
SPRINGFIELD --
1
"``' OREGON
vn .spdngfieldor.gov
811-SPR2014-01739
639 W CENTENNIAL BLVD
CITY OF SPRINGFIELD
225 Fifth St
8pdngfie1d,0R 97477
541-726-3753
permitcenter@spdngfield-or.gov
RECEIPT NO: 2014001744 RECORD NO: 811-SPR2014.01739 DATE: 08/12/2014
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
TOTAL DUE:
225.00
Big Sky Hospitality
1276
Springfield, Oregon
DBA Lil's Deli for
639 Centennial
225.00
TOTAL PAID: 225.00