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HomeMy WebLinkAboutPermit Signage 2010-8-17 225 FIITII STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 1;....3 e;J ,.,.-Ij ~l ~ j Job Location , -j ~ Assessors Map ~1 l~ Owner of Property ~ '~) Address .,,,...Ij City r:~.'J 1 Contractor/Installer Q t, -, Address ~4 ~ ~ City ~ ~. crt!1' ~J 1 Date of Installation e> e> " \j " II ~ tfQ\ ~ rtl!JJ l~ tlj ~~ j . l J j fll Signature ~ ~I ........... Date of Application e; I~ Issued By ,I I .'~I " ~ ~l .. . " \ ~~ ~ Co~2OI"-OO {,{,(, . , CITY OF SPRINGFIELD, OREGON SPRINGFIELD ~~ CityJobNumber :>\>/2..10 -000 7'1 17/L.( }1.-1AtN i ,u'S '36 3 ( s,. Tax Lot Df 260 5v..~>~-f.- 9"/ S Otl-(L Lv&s-J.-r::<-h sl- d-e LLC /05"0 Phone c:P- ~ 6-E:'?./~ Zip 97l(O ( State OWN(:(L ~ /~te Phone Zip Construction Contractors License # Description G..... .,1.A......CA4 - ?~'^A'" {3: 8k,JD Expires &-//~6 / / Date of Removal / / $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 $100.00 deposit if the display has been removed. ()LWrU h)~ Date ~/7/'::> I I For Office Use Job# S'Wl.IO ..000 Receipt#ZOIO - 0 C; z. crZo..:=- Amount Collected Shared Drivc(T:)J8uilding FonnsIBlimp]ennants_Balloons 7-GB.doc . ' . S:~IEL~ ~~tt. ~.O'REGON ..- . - ., ..e,,' ," CITY OF SPRINGFIELD 225 Fifth 8t Springfield,OR 97477 541-726-3753 TRANSAC"Ti6~ RECEIPT ':"~~',:.~ . wWN.ci.springfield.or.us permitcenter@ci.springfield.or.us RECEIPT NO: 2010000092 (!5~s~G:Bl!li161r". ''P''v'' Blimp, Balloon, Searchlight Tech Fee Adjustment Admin fee (10% of applicable fees) RECORD NO: 81 t-SPR20 I 0-00074 DATE: 08/19/2010 -~ -.,.. F;./i'.:;,....,.. ~ ' ., . ~AC.COUNT.CODE ":', .' :.:.....~"AMO'UNT.D.UE....L.....:;.cd -'V' "P-"'i i?>'i~~'+",,^ 224-00000-425602 1 00-00000-425605 224-00000-426605 --- TOTAL DUE: ~i>A,(IVIENT~Tr,(F'E?, 0' F'AYOR:.i0.,$CASHIER:6'Bq~SBY.iy C9MMEN"[S " Check enliven inc .' . <, -"", $80,00 $4.00 $8.00 $92,00 !',M,Q@I:pAID ':,' . $92.00 ,j 10224 ~., , . ",.'; ,'( 'jl.' : r, C '1(-'1 f" I . \..... t.. .. (, . I.., 7'" ,;:.';. ~::~1'l'.1F.: ~-~ . ~'. c\i::;"', 'J ,,' i'.r , - .' .- ..~ .~, Ji~: "j ,