HomeMy WebLinkAboutPermit Signage 2010-10-14
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CITY OF SPR[NGFIELD, OREGON
225 11m! STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (54])726-3689
~: 5fD .00 51 'J
<e>) City Job Number
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Job Location I 2 (0 #0 '-fA lll'(.
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Owner'of Property
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Owner
Address
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Contractor
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Date of APPlication/?;/~/O
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For Office Use
Job# 5/()-CO 51?
Address
Phone
10/10110
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' within 30 days
from'the date listed above. If the banner(s) and/or portable sign is not rcnloved 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) and/or portable
sign(s). This inspection will begin the process to return the $100.00 deposit if the banner(s) and/or
portable sign(s) has been remo~ed.
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City
State
Construction Contractors License #
Description_ ~ l>'11!1. \f1..Q.fJ 1 V Ct. vcJ...
Date of Installation IO/r;ftO"
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Date of Removal
Issued By
Amount Collected
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Receipt # cDr 0 ~ .5 7 J
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Sl1ared Drive (T:YBuilding Forms/Banner]ortable Sign Permit CSD 7-Q8.doc
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'''/\ OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00513
1210 MOHAWK BLVD
CITY OF SPRINGFIELD
225 Fifth 51
Springfield, OR 97477
541-726~3753
perm itcenler@cLspringfield"or.u5
RECEIPT NO: 2010000573
[DESCRIPTION ",:ik.:,'r',
Banner, Portable
Technology fee (5% of permit total)
Admin fee (10% of applicable fees)
RECORD NO: 811-SPR2010-00513 DATE: 10/14/2010
'c". ,;.',~:!0',.c.~\"'> 'c.. .;""c' ..'.... 'ACCOi.JNT:'cobE~;ii.. i';.",' AMO.UNYbue'.'O> -I
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224-00000-425602 $100.00
100-00000,425605 $5.00
224-00000-426605 $10.00
TOTAL DUE: $115.00
, PAYOR'CASHIER;NMACHADO" -' :CJ:>MI'!IEN:fS'"~1':;"." "s,'" -.:" : 'k'~M.9JJ..&T;Ii~I.R-;ioi"
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$115.00
$115.00