HomeMy WebLinkAboutPermit Signage 2010-8-17
225 FIITII STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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........... Date of Application
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, CITY OF SPRINGFIELD, OREGON
SPRINGFIELD
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Date of Removal
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$202.00 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 display will be
removed within fourteen (14) days from the date listed as the date of installation above. If the display is not
removed within the timeline specified, I will forfeit the $] 00,00 deposit. I also understand that this special
permit can be issued only once per calendar year per development area. I also agree to call the inspection line at
726-3769 by the end of the ]4"' day to request an inspection to verify the removal of the display. This inspection
will begin the process to return the $100.00 deposit if the display has been removed.
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Amount Collected
Shared Drivc(T:)J8uilding FonnsIBlimp]ennants_Balloons 7-GB.doc
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CITY OF SPRINGFIELD
225 Fifth 8t
Springfield,OR 97477
541-726-3753
TRANSAC"Ti6~ RECEIPT
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wWN.ci.springfield.or.us
permitcenter@ci.springfield.or.us
RECEIPT NO: 2010000092
(!5~s~G:Bl!li161r". ''P''v''
Blimp, Balloon, Searchlight
Tech Fee Adjustment
Admin fee (10% of applicable fees)
RECORD NO: 81 t-SPR20 I 0-00074
DATE: 08/19/2010
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224-00000-425602
1 00-00000-425605
224-00000-426605
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TOTAL DUE:
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Check enliven inc .' .
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$80,00
$4.00
$8.00
$92,00
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