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HomeMy WebLinkAboutPermit Signage 2009-6-5 r~' \: ~ ..~ ..~ ~ ..._J~ ~l ~ .~ ..~ t ~ ~ ~ "~ ~ ~. e ~. 8 II I, '. "@ ~ ~ . 4 ~ ~ "~ ~ ..~ ~ ~~ ~ ~ ""':-.: I M 225 FIITH STREET. SPRlNGFIEW, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 City Job Number (~q.... \C\G\ Job Location :3b l S~I s:..-1-- AssessorsMap \l11)3~n\() . r J:axLot r~~oO .>:""""&~,oI;"f{~~~~~s.1':'1$i"'M~c.rF~J1l'-;-~~m"''',i~~~r'"q,~,,..-~. -"<"\; "Iii "'~~'7'fl'7'~0"'(T?:.;:;:n"::,~-~~~_ ''f-~'''''~~$;>~Ii'''''''f"'~~~~~'="''"\''''O'f~' ~1<\.O.' - ,rl11::,l;: i~1iPJ;,}.)~~:!;t~t '''''- :-;4~~4"'f~.,)~\';ii'Ji~;ij\~:U~'i~Y;.t~rfr:'f.-~nWftJ4t",.;~{{'2'iW;Y~-d'T;;if;.;:,g~&"'\f:/t1~.;r _j\ii1t~"t,~!:Gs. :\, ';'i&:f:/~Y?0i -if:i;!h:mr~1_tMY' ~1~0~~;'tQ~, _ t~:e~~;;~:::~~~fY\AsR~.~~..:0""~~~":"~'!.'~'i'"'~~'':-~"'~~~'\~~"'~"2>"\""'."M>~'~' Adclress_9D7'5/' ~/''C~'IQ(Crr) Phon" /~l!~cr:rn City rl '~l)- V\.O~ State11!L Zir ?"7 ID d. {3C::~ ,{::l~~/[.;~:r;;~~v':~~~~}?~i~~~~~,~-~~~-~~,,,',f/-';~~t'r~, ~et~~t.fJ~~Ifi!i~,~'_:;ilt,~{;""~:J-::'$i;'\Plr;::~,"'f.~...,::..r..._~~! ~ 7'\.::--~;:1 ~rCoittracto;niis'tal/er/Id'Jf~~iff{t'~~~i'kl!f~~\~1~:.,~;~Jj.:'~~~iiJ~~;l11oi3;~~~:~tZf;.'~~~~?t?f!<q>::1:~-~lffi;;J~,~~-:j,~~M~;ittfi.~j1;~i\{<,,:><;~.):j M..t:..:.....;;.:.~~z.t.1.,;/~-;!.O-.$l.\-..~Str..:o~;;)i:~~il""-,." --~-'iii~3, ~,,~~;;..;..;i?;.; _,;i.J....:>......;.~. , '. .~--'.1t.i:.c-:)j:H~" -"_,,;~,-,;,rie-4~_ ...-"&4"......00 ~ 'ilif~~ -- ,"':: $,_> ",^./Oi Contractor AddressSA-VY~ As A6nl t-0' PI' on" City "tate Zip Construction Contractors License # Expirf'< Description luJI' 1'\.0 -f('O' -tZz-der\ )/-PIIDW l/ xg DateofInstallatirm ~)nQ A/-h 09 DateofRemov~l ~\\~ ~I-h 09 Permit Fee: $225.00 including '$100.00 Deposit and applicable fls. ' 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 bannerCs) and/or portable sign(s) is not larger than 60 square feet, and will be removed within 30 days from the date listed above. If the banner(s) and/or portable sign is not removed within the timeIine specified, I will forfeit the $ I 00.00 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 inspe'o '11 begin7;e pro <s to return the $100.00 deposit if the banner(s) and/or portable si as en emoved. , . 'Y:..J.'........... / /..e.- G.-<\~~~ Signat!I&' _ / Cf:10-L . -.. , P Datp ~~...,.;J~~.")~".I;w;.'.lj'0:\~,=. i~':~"'-.t~;;f~~~';' 3V-:{S~."t;- .~.~~:~~:~ri~,,"~:Nl - ;ft.~fti').~;:,p-- l"...-.'t/'[~ ~->_~. ~,::;,;"',,-:~"'jkt_~'v~_,r,~:\~;" _.' -, :,:~,,~"_~Tf:-9fflp~ .,S! ~:::;~:~:::::: ~To'~.Er.("~~t~"4~~~;~d'rtt'~7q' '",,"'By ~ r~'\~. Am"M(CoII~(o' :tl f~id1~;'S:~1{..rfJ~ Re~~ipt # J1yUj)'Q-1Dt1 L~:). 00 Shared Drive (T:)lBuilding FormslBannc:r]ortable Sign Permit CSD 7-08.doc 22SrFiftli Strcet Springfield, Oregon 97477 541-726-3759 Phone :~ 8i:.. . City of Springfield Official Receipt Development Services Department Public Works Department RECEIPT #: 2200900000000000617 Date: 06/05/2009 2:03:28PM Paid By OREGON HORSE CENTER Item Total: Check Number Authorization Received By Batch Number Number How Received nJm 4096 In Person Payment Total: Amount ()ue 100.00 100.00 5.00 20.00 100.00 100.00 5.00 20.00 100.00 100.00 5.00 . 20.00 $675.00 Job/Journal Number Description COM2009-p0798 Banner Special Permit COM2009-00798 Deposit COM2009-00798 + 5% Technology Fee COM2009-00798 '''+ I 0% Administrative Fee'" ::..COM2009=00799==:J Banner Special Permit (COM2009-00799::=J Deposit ,COM2009.:00799 _ -.J + 5% Technology Fee COM2009.o0.9199---t'+ 10% Administrative Fee'" COM2009-00800 . Banner Special Permit COM2009-00800 Deposit COM2009-00800 + 5% Technology Fee COM2009-00800 "'+ I 0% Administrative Fee'" Payments: Type of Payment Check Amount Paid $675.00 $675.00 cRccelotl Page I of I 6/512009