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HomeMy WebLinkAboutPermit Signage 2009-5-8 IJ I. '. .. re';:"l ~~ r~ -~ ~ (fI- I, ~~ ~~J ."~4 ~ ~ , I~ .~ .e ~ f" Ij ~ ~ ~ ~~ . - , . Q ~) '. " . CITY OF SPRlNGFIELD, OREGON s~ l~.~ . c.oP7 200Q-C:XX)'70 CIty Job Numb.. {', { /(,00 J 6-1--L.. -sIp 02- Tax Lot Owner A~dress 4 ~" yJ1IJ.rlS F/~/d 5+- City - -S ,Do.r f'C) F'~ Jd Sta1efl/2.. Phon" 5l..(1-'}S~ /9r..C( ZiJ: 0;7Lf77 Contractorllnstafler Contractor frvt1-ertfcA 1'( w\A +-1-\2.... SS +l-\. Addre<< 4 D7 S fA.) I r . 'Eu C? PYI-<' 0 CIty Phone 54 I - 3<13 - '2 bO,O of? Zip CJ)lfO"2- "tate Construction Contractors License # Expirp< , O .. ~~1:e"" escnptlor . o"'!te of Installatio,' '-{-7. g .09 Date of Removol t;. 2& '09 Permit Fee: $225.00, including $100.00 Deposit and applicable 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 the above described banner(s) and/or oortable sign(s) is not larger than60.squarefeet,.andwill beremovedwithin.30.days, from the date listed above. If the banner(s) and/or portable sign is not removed within the timeline specified, I will forfeit the $100.00 deposit. I also understand that this special permit can be issued only twice per calendar year per development area. I also agree to call the inspection line at 726-3769 by the end of the 30th day to request an inspection to verify the removal of the banner(s) and/or portable sign(s). This inspection will begin the process to return the $100.00 deposit if the banner(s) and/or portable sign(s) has been removed. Signatur"~~ 12 b~ ' Oat" L/- }O-oCf Date of Application IS~Ued-B~ I For Office Use /X" /6 C) Job#L9 , /X()~ Receipt # ___;1/ ,A d ): (j)) Amount Collected I j. Shan:d Drive (T:}lBuilding FonnslBanner]ortable Sign Pemlit eSD 7-08.doc ~eceiPtNo:.!;00900~00000000342 ~I Line Items: Job/Journal NumlJ Tran Cod COM2009-00579 COM2009-00579 .. COM2009-00579 COM2009-00579 Payments: Method CreditCard 1065 1049 2099 1098 Paid By AMERICAN MATTRESS/LEROY BRAZIL Transaction Log For Date: 05/08/2009 Oplil....r1u1ior Banner Special Permit Deposit + 5% Technology Fee "'+ 10% Administrative Fee'" Received Check Q.. Nn NJM Page 24 of 30 ... 5/11/2009 1:21:04PM City of Springfield Development Services Department Public Works Department Revenue Account No 224-00000-425602 821-00000-215500 100-00000-425605 224-00000-426605 Amount Paid $100.00 $100.00 $5.00 $20.00 $225.00 Line Item Total: Annroval # How IL=I In Person $225.00 Amount Paid 059971 Payment Total: $225.00 r cTransactionLog.rpt