HomeMy WebLinkAboutPermit Signage 2010-10-1 (2)
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
~
o City Job Number
..~
..~ Job Location
..~
Q
~
~
..~
>
~
~ City
~
~
..~
~ Address'
I
8
I!
~
'~
~
~
....~
~
~
~
~
~
I
~
'. , CITY OF SPRINGFIELD~ OREGON '
'. j, >
sVOIL"Z.OIO.O--O 1..(24
2043 0 L'/""" PL' <......
"O)2S42
~ 0 7CJ a
Assessors Map Tax Lot
;=e;':f';~o;:;W6~D>""H<;~~;l/ "." '2(1'?'7 ""oLY~/: ~'- """ ,
AddressACY/3 &- ()IMJPZ'c:.. . PhoD" 2E- ~f0
c;PJ5..-r;l/6-;::Z;ELlJ State OR Zip 9'/9'77
Phonp
City
State
Zip
Construction Contractors License #
Expire<
Description
~1?77JfSLE
5-/'-#5
Date of Installation
IO-j-/D
Date of Removal
Permit Fee: $225.00 including $100.00 Deposit and applicable fees.
By signatnre, 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
banner(s) andlor 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) andlor portable sign is not removed within the timeline
specified, I will forfeit the $100.00 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) andlor portable
sign(s). This inspection will begin the process to return the $100.00 deposit if the banner(s) andlor
portable Sign(s)~n rem~ //..--.i _ _
Signaturp ~~ Dat" /0 I 10
Date of Application
Job# SID -00
Receipt # Zorc - Co " b Y
lIS-
Issued By
v{?
Amount Collected
SL// 1.9/'/0:; 60
"f,? P-\ A ~
Shared Drive (T:)lBuilding FormsIBanncr]onable Sign Permit CSD 7-08.doc
_J _ _ .~
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00424
2043 OLYMPIC ST
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield,or,us
RECEIPT NO: 2010000464 RECORD NO: 81 I.SPR2010.00424 DATE: 10/04/2010
IDESC!l!P'rJON':~--:"- :~;:~:;;i:'-;~';~~f't~"='1i'F~~_~.c::C_0j.fNf:::C911E"~':'f'~i(i,tOJt~TiDUE' _~i:",- - "'l
Banner, Portable __ 224.00000.425602 $100.00
Technology fee (5% of permit total) 100.00000.425605 $5.00
Admin, fee (10% of ap['licable fees) _'__, 224.00000.426605 $10.00
TOTAL DUE: $115.00
fSJ,'cif'."'.Y, M.. ENTT.Y..P_.E. ::;:,.::[fA,....Y, OR'; - CASHIER:DB6WuiBY'i;"-';'COMMENrS-i1fc.,Zf_-:;:;?'=~~"-?:":.::"'i:~AI\I10UNTf'AII):' r; .'-:-~. q
_" _.. ~. _. ~ ~__ . ., . 'lti!!iili;;:l:'L__~~.. ______~_ .
Credit Card
214055
brian proett
$115.00
$115.00