HomeMy WebLinkAboutMiscellaneous Miscellaneous 2000-10-23
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~ DUPLICATE RECEIPT DUPLltm RECEIPT
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CITY OF SPRINGFIELD
225 FIFIH SIREET
SPRINGFIELD. DR 97477
(541)726-3753
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WELCOHE TO DEUELOPHENl
SERVICES AND PUBLIC WORKS
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REG-RECEIPT:Ol-0003562 C:OCT 23 2000
CASHIER 10:001 11 :35 am A:DCI 23 2000
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1065,BANNER/BLIMPS
JDB#:OO-OOOOO-OO
1049 DEPOSIT (BLDG)
JDB#:OO-OOOOO-OO
$40.00
$100.00
TOTAl. DUE
RECEIVED FROM:
JEFF CICHOSZ
CASH:
$140.00
$140.00
TOT AL TENDERED
$140.00
CHANGE DUE $0.00
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'Pay Name :JEFF CICHDSZ
',Mail Addr :5755 MAIN STREET
*cty/St/Z :SPRINGFIELD DREGOI~ 97478 .
*S1te Addr : ALBERTSOil' S
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,: TtjANK, VOI~! ! ! ! ! ! ,
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DUPl.ICATE RECEIPT DUPLJCATERECEIPT
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SPRINGFIELD
TRANS#:01-0003562
DATE:OCT 23 2000
.00
E:
??5 PIFWlS/IlIlIfR fOOl
SPRINCI-IELO. OR 9/4//
(541) 726.375~1
/-AX (51/) 12G.3li89
UANNER PERMIT
COMMUNITY SERVICES DIVISION
225 Fifth Strw
Springfield, Oreg\ln Q7477
omc", 726.3753
INSPECTION I.INF.: 72f,..17{,9
Uanner' Location:
C:;/C;C; VY\Al,..l
/'7 -0'1..- -; Y Lf4-
p.y{3~Sol'ij
bOL '20
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Ass~s:mr~ MM.p H:
Tax Lot
~()I
Owner of Property:
~,O ,
BOlc:,t;
!
C7J'( .,
Address:
Phone #:
f4t2/~~~.
"6'?/'2.-h
City:
rJ)A'11\)
Sel.f
State:~
Zip:
COltl raclor/lnstaller:
Arlrtt'es~:
Phonr #:
City:
State: Zip:
Construction Con'raclors Registration NumLlcr:
F.\:pires:
Dcsr ripllon:
Dote of In!lltnllatinn:
10-;).'-\-00
Dale or Rcmov"l: I \-~ -:00
L1anner Permit ree S40.00
Dcposit Required $100.00
By .!Iignature, 1 state ami agree thl:l.t J hl:l.vl: cmcrully completeu this application alh.1 hereby celtify thm all
infonnation herein j", tme and correct. 1 further agree anu understand that the above described banner (s) is not
larger th3n (,0 !'lquare feet, and will he removed within 14 day~ from the date listed iJhtlve. Jflht.: bl;\nner(s)
if, not removed within the timeline ~peeified, I will forfeit the $100.00 deposit. f also undersliJnd th~11 lhi~ ~pt.:t.;ii.l1
pelmit can he i~~\Jed on ly t\vice per c~lendar year per development 3rea. I also agree to call1hl' inspct.:tion lille al
7'2(;-:';7(iQ hy the end of the 14th day to reque~l an inspection 10 verify the removal ot"thc b~\Ont.:r(s). Thi~ illSplJ(liurt
will hegm the rrnc:e;;c, tn relum the $1 oo.on dcpo~it if the nanncr(s) has h<<.:cn rcmovcu.
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OFFICE I]SF.
Dull: of Appliculion:
Jllh #:
RXCl:ipt If: _.
I'SlIed I\y:
AmulInt Collected: