HomeMy WebLinkAboutPermit Signage 2006-9-27
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22SfIf"III,IRFrT _ ,PRINCrn:LD,ORg7477 - I'II(S41)72G-'7~;q -lAX (S41)72('-%8')
CIty Job Number
('Jr:, - ul2-f-D
/71/J CN-rtJ{/~/A-(
/ //):! 25' Yc;i
Tax Lot
OS lOV
Job LocatIon
Assessors Ma;,
OWlIel
Owner of Property VVk l(M"" ~~IW'~S
Addre~' 11/ D (/-4/l k.~;11 J
City SDr;Il",/ic./J State dZ
. (
COil tractm//Il stallel
Phonp
717- '-ftft.J,-/
Z1J; 97t..J 77
Contractor
o IA/..f /0'<:-
Addres'
Phoro>
Clt:'
State
7:1['
ConstructIOn Contractors License #
eXf-J 1"-"'-
DescnptlOn Z X 8
~.....&~
/
q - I- 7 - Db
Date of Removal
Date ofInstallatlOn
PermIt Fee' $16\ 75 mcludmg $100 00 DepOSIt.
By signature, I state and agree that I have carefully completed thiS apphcatIon and hereby certifY that
all mfonnatlOn herem IS true and correct I further agree and understand that thc above descnbed
banner(s) and/or portable Slgn(S) IS not larger than 60 squdre feet, and Will be removed wlthm 30 days
from the date hsted above If the banner(s) and/or portable Sign IS not removed wlthm the tImeline
specIfied, I Will forfeit the $100 00 depOSit I also understand that thiS special penmt ean be Issued
only tWIce per calendar year per development area I also ab'Tee to call the mspectlOn lme at 726-3769
by the end of the 30th day to request an mspectlOn to venfy the removal of the banner(s) and/or portable
slgn(s) ThiS mspectlon Will begm the process to return the $100 00 depOSit If the banner(s) and/or
portable slgn~en removed
slgnaturp&f~ 60 Datp 1- 2-7-D{;
Date of ApplicatIOn lIz/At:?
Issucd By iJJ/J m(J/JUV'
FOI Office Use
Job #....ctc - /2 ~O Receipt #
~ S
Amount Collected \ JJ .I (g / 1-
Shared DnH. (T )fBUlldmg rormsll1.1nner_Portable SI~'TI Pcmllt CSD 8 06 doc
225 Fifth Street
Sprmgficld, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2006-0 1240
COM2006-0 1240
COM2006-0 1240
COM2006-0 1240
Payments
I ype of Payment
Cred ItCard
CRel.elOl1
RECEIPT #.
Description
Banner Special Permit
Deposit
+ 5% Technology Fee
+ 10% AdmlDlstratlVe Fee
PaId By
PAUL B HARMON
elf.. of Sprmgfield OffiCIal Receipt
D ,opmcnt ServIces Department
PublIc Works Department
1200600000000001456
Date. 09/27/2006
Item Total
Check Number Authorization
Received By Batch Number Number How Received
dim
517254 In Person
Payment Total
Page I of I
I 45 57PM
Amount Due
4500
10000
225
1450
$]6175
Amount Paid
$161 75
$16175
9/27/2006