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HomeMy WebLinkAboutPermit Signage 2006-9-27 ~ o -- (/), -- ;> -- o (/), (U u -- ;> ;,.... (U r::/), ;>. ........ -- ~ ;:::$ s s 0, u I ~ -- s (u, P-oi, ~ OJ) -- r:/'ll (U ~, .~ t 01 P-oi ---- ;,....- (U ~ ~ ro t:O $f?~:XO:1?tG!u..u. C.;- ~- ',! " 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