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HomeMy WebLinkAboutPermit Signage 2014-08-12225 FIFPH STREET o SPRINGFIELD,OR 97477 > PH:(541)726-3753 • FAX: (541)726-3659 0: a, 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 G'/ 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 _ P� 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