HomeMy WebLinkAboutPermit Signage 2009-6-5
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225 FIITH STREET. SPRlNGFIEW, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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Contractor
AddressSA-VY~ As A6nl t-0'
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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. ,
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Re~~ipt # J1yUj)'Q-1Dt1
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Shared Drive (T:)lBuilding FormslBannc:r]ortable Sign Permit CSD 7-08.doc
22SrFiftli Strcet
Springfield, Oregon 97477
541-726-3759 Phone
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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
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