HomeMy WebLinkAboutPermit Signage 2010-10-14
225 FlffiI STREET. SPRINGFIEW, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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Construction Contractors License #
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Description ijc-.II\V\lIr ), "-(01 Id- 9')V\ S
Date of Installation /o/6fto
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Date of Removal
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Permit Fee: $225.00 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
banner(s) and/or portable sign(s) is not larger than 60 square feet, and will be removed witllln 30 days
from the date listed above. If the banner(s) and/or portable sign is not removed witllln 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) and/or portable
sign(s). This inspection will begin the process to return the $100.00 deposit if the banner(s) and/or
p~rtable Si~)~ /irmoved.
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Date of Application / 0 I~ ,(;>
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Job# SIO -0 c> :5 ( I
Receipt # 20(0 . .; 72
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Issued By
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Amount Collected
Shared Drive (T:)lBuilding FormslBanner ]ortable Sign Permit CSD 7-08.doc
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TRANSACTION RECEIPT
811-SPR2010-00511
6 W Q ST
CITY OF SPRINGFIELD
225 Fifth'St
Springfield,OR 97477
541-726-3753
pe rrn itcenter@ci.springfield,or.us
RECEIPT NO, 2010000572
RECORD NO, 81 I.SPR2010.QOSII
DATE, 10/14/2010
Li;lESCRIPTION'C':,. '*'{", 'r~".. "'7yi:;:;';~.,.,~~:,y1J ',c~C.C~QJjNJc:.QQI:C;1";c "8.MQLJIII,LQJJI:1,'; . .1
Banner, Portable 224.00000.425602 $100.00
Technology fee (5% of permit total) 100.00000-425605 $5.00
Admin fee (10% of applicable fees) 224.00000.426605 $10.00
TOTAL DUE: $115.00
LPL.o?-X.ME.NTTVeg,;:; /P.A Y:0Ir:',,\'<CASHIER'NI;'AC.HAD6.7;"C.QMM~Nk$"';".i:;;~1f;;J:;:'00;..7{ ... Zll:~M..OUNT;PAIl:i:',;;' ',"
Cash
michael herron
$115.00
$115.00