HomeMy WebLinkAboutPermit Signage 2010-10-6
..
~~F: CCb10-0orJR
CITY OF SPRINGFIELD, OREGON ,J' ,
225 F1ffiI STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
~ cl
.'<r-4j CitYJobNumbe~tZOI()-O~ 4 Db
~j .
tl Job Location I 'f J () M ^ h A .... 11' 0 I t/ d
~ Assessors Map 17 0 S 2 S Z. ~
~j
SPRINGFIELD
~~
Tax Lot
() SSOC
l~
~I
~j
IQID)
."~i
" Ij
~I
~j
~
~j
~J
~
~
.............
V!J.l
~I
~I
~
~
" Ii
" I,
~l
~.l'olj
~\
'-.
Ci{1lJ
J~
~j
~j
~~)
~'
~I
g:~1
,-1
~f
~
~i
~
~Er\l
,-1
,-1
~I
., <r-4j
" I,
~\
~
~ t:. " hs,,~ (LJ2& ~.ed ''''I f[D7t~ CO'lY11/<q .:c.......),
goo"! ..,.0.1 nr Phone \l.(1 -1t.y-?J\l.3
,,~_ Zip '1'1l.f?n
Owner of Property
&, i bso"",
(},
,.... Phone
Date of Application
For Office Use
5/0 .(t()L( Y6
Job#
. "'Ol() - $ 'llJ
Rece.pt# (;. .,
9z-
Issued By
'ba
Amount Collected
17Y 70
Construction Contractors License #
I~~~_-h
I () (
.
Expires
:r:-sSlAt--d ~Jrl'ut..el)
Date of Removal Jt) f {, I/o
(~.1lO IDclUumg $106.66 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 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 14th 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.
lo/d,,:.
.
Address
f 0 a oJ(
J'"'I
City
{)o r. ,.J u 11,,1 .J
State
Contractor/Installer
riD/...""""
D{c...t,(~CJ"""
Address
po
~.t>_,
/J.e-'i.d LuO 1/.1.
State hi\.
Zip
fld ')C
.P
City
Description
Date of Installation
Signature
~
()~~
Date
Shared Drive(T:)IBuilding FormsIBlimp]~ts_BalloonS 7-08.doc
225 Firm STREET. SPRlNGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689
~: Sptt.ZCtO -ODll?b
~) City Job Number
."~4
r:tZll
-.~ Job Location
-. ._1, Assessors Map
Ql
~J
~
0)
...~( l'\ n r)~
i;: Address r 0 "..,;) \( fl '
~ City (J~4-d"J^-Gd
~
Contractorllnstaller
~>
~- Contractor
.....__I{
~l
-~
,:;;;,,:
I~:
_i
~l
,~I
-I
~
U
IJ
I".:'.
.'!~l
~l
,I
-I
~
f," Ii
~l
~.
~m)
....~l
~
Q!);
., -14
.~
~
-I
~
f'l' Ij
---
i!~
~l
~l
~~
Io:)OIJ
Ml
'-
eer:-: eel) /() -0013 g-
SPRINGFIELD
~~
I
CITY OF SPRINGFIELD, OREGON " .
1~3d Mo~~~1(
170325. 'Z.l(
r1\ucl
o S$""O C
Tax Lot
Owner
Owner of Property 6,.; ~ So...... 4 (,.. ~O'"\-
(L~f(.<;" J
b 'f 'To ,...., co"'.....; ~ .L""'C
Phon~
State () It.
Zip
17 \f'1O
'J{J tV\
o . ' c.. c.{ .e..M' 0"",,",
Address
p" g /l~
rrA~~
Zip
crt'i"JO
JI
Phone
7~1- ~'v- fd<O
State () fl.
City
Construction Contractors License #
Expire.
Description
"gA-.N"Hl!'Jl / 1""-7 MI.~
,
~1'Lt&A
.Is s CA e:~
~I' '--
.
Date ofInstalll!.tion I f) - I '- I () Date of Removal / 0 - 6 - I 0
~ "-
/ I $' ~rmit F.ee:-.:$225~OOjl1<:ljfdiiilf$IOO:OO'l>epiiSifti1lll applicable fees.
By signa ure, I state aud agree that I have carefully completed this application and hereby certify that
all information herein is true and correct. [further agree and understand that the above described
banner(s) and/or portable sign(s) is not larger than 60 square feet, and will be removed within 30 days
from the date listed above. [fthe banner(s) andlor portable sign is nct removed within the time line
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 ins'pection 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) has been removed.
Signaturp
1.4.
.
LT----i ~
Date , fJ- 11 - 1 6
For Office Use
Job # 90 - 00 t.( 8' b
. Date of Application
IOft"/O
Oa
Amount Collected
Receipt # ZO/O - S '3"(
Ilr
Issued By
Shared Drive (T:}lBuilding FormslBanner]ortable Sign Permit CSD 7...Q8.doc
; . .
SP._RING...F IE.~"
~lA_'
~; @\1
;;A'OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00486
1930 MOHAWK BLVD
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or,us
RECORD NO: 811-SPR2010-00486 DATE: 10/11/2010
j is: ';;;i;;;;';- '~~;'{?:.:r ,,;,rt';;;''''/\C.G,QUNKCdoE -:.-" . '~~";'!\MQultt.pJJJ: -. '. . ,,"" ,1
224-00000-425602 $100.00
-'-
224-00000-425602 $80.00
224-00000-426605' $18.00
100-00000-425605 $9.00
TOTAL DUE: $207.00
[J;A'(I'I[E,!':1;rJ:.y,);>E#~;';RAY0R;'2;;""'cAs8IER:j186i(Vts8'Y: :(:c.:QMIVI~E;~i$l;""i;l9-;;: ',"";','/"'-j;),0;i",,,AMOUNT-RAID . '. - - "I
RECEIPT NO: 2010000534
[OESCRIP'nON;';,:. .;'--;.;~':'
Banner, Portable
Blimp, Balloon, Searchlight
Admin fee (10% of applicable fees)
Technolo~y fee (5% of permit total)
Check
2904
john dickerson
$207.00
$207.00