HomeMy WebLinkAboutPermit Signage 2009-5-8
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. CITY OF SPRlNGFIELD, OREGON
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. 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
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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~
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For Office Use
/X" /6 C) Job#L9
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/X()~
Receipt #
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Amount Collected
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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