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HomeMy WebLinkAboutPermit Signage 2010-10-1 CJ:s6E-!' CO",", Pf~~_ ,""', SPRINGFIELD L.'~-:--O~" ) . ~ lit. "',,.' ", .,4l!;::Ij ZZ5 FIfTH STREET. SPRINGFIEW, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689 ~~~~~~;".:~ ~ ~, .E~' , r- " 1-; ~;'\: ~, ~, L~. ~: ~'C\',\ ~" .' -=.i, ~. .___,.1: ~I U ~I roc ~., OO"'.~' , .., , ';,jf.J --- r;I!>, ~; ~, \;,..h 1#\,. \;....// ,.-=1'. ~, ~i f,V{'\j ~: r;",' . I:IIJ.' _. ,r J~_~: ~< ~1 ~; ~j ~, ~i .' ~,~ ~i ----- ~"'\ ., e,r':1' r-- ,~ r^ ~ .,,~j , Ii ~l '<"~"", '{,....~ ..:..:,~"<.::",, ,~?"I: ,.:~..:z,...-"z'~~~::'~?""":\:,,,:_.r . <<,,,,,..,,,,:<~ :,~ ~.~, :'-- -1-:~""'~t,;;... :,:? ,'. "', :~:,. 'Glfi1YJf>.BSl?RillN:@FIEL'ID. €)REGON~: " -, ; ''','' ,; .' , ~ ~ "_ "'"""\t..~:-,,:- _" ~;'1 ,":~"'--~;;'i.-~ ,""4;:....."f~..,,~', ~,--::-- ~'_.. ",' +.t ~ , , <<! .l)fl. "'^{tJ-OC Y z."5 City Job Number ;;;:.,. t.>' ZOL(~ QLyW\ fie.... Assessors Map I 7 0:5 ZS4 Z. Job Location OD70C Tax Lot Owner of Property (A)~/1/,[) Y Mt-FA/ Address 2.l'j ~/ 3 OL (,lJ'JPTr.. City ~ pf?J:A1..r-.-Z:FLT) State -.,0 UJ /// 6J( 2--i ~ 7 o LytN'\.t?: c.... 22??,3?l1l 97f'7.7 Phone OJ< Zip Contractor/Installer Address Phone City State Zip Construction Contractors License # ~IJ- LL 0> Q>-A/ Description Expires ;J- ~/lfV/.JI!Jj? Date of Installation .... , )(3 -1- /0) / . . 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 $100.00 deposit. I also understand that this special permit can only be issued twice per calendar year per development area.' I also agree to call the inspection line at 726-3769 by the end of the 14th day to request an inspection to verifY the removal of the display. This inspection will begin the process to return the $100.0 eposit ifthe display has been removed, Signatu In ~/-/a o.~ Date of Application 10-1-10 --:::t:. ~ Job# SID ~ 00 '{Z'1 4'=-, Receipt# 20(0 . 9Z- Issued By Amount Collected Shared Drive(T:)!BuiJding Fonns!Blimp _Pennants_Balloons 7-OB.doc ~ FI www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00423 2043 OLYMPIC ST CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 permitcenter@ci.springfield,or.us RECEIPT NO: 2010000469 RECORD NO: 811-SPR2010-00423 DATE: 10/04/2010 [DE~CRIJ'"TLQtf':l~~' r:'"~;;;'~Y;:?~22";~"""i:~%;!c,,,'. ,::':".;;;i"':~~'~ .gQ.c.c:>.UN."Tlc.l:!ol; . ::.;. 'i((:?';AMQI.tr:!;r OJ;!.E' '. Blimp. Balloon. Searchlight 224:00000-425602 $80.00 Technology fee (5% of permit total) 100-00000-425605 $4.00 Admin fee (10% of 'Pplicable fees) 224-00000-426605 $8.00 TOTAL DUE: $92.00 !.f1AYMENTTYf1Ee~J",oAYO R', ,:'tC'ASHIER: DBOwLSBY"-"i',.l,'COMMEN' TS,4','},/"f',;_.f.-;"';' c. 'A"."M'.O_UNT.':'A,IP" '''...... ,.,,',.1 ~..~~...,_~~..~.:.:..l~*'i._~,.,_"" fu' ".. ~~~.._~..._...., "', . _....""~~~__,._.~,.'.."~_M..._.... .......___..."f"....".., ~ Credit Card 214055 brian proett $92,00 $92,00