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HomeMy WebLinkAboutPermit Signage 2010-12-10 ~ ~. . ,;.A ......, ~ ..~ ..~ ;;ar.: -.. ......--Jt ~ ~ ~ ..~ >- ~ ~ ~ ~ -..~ ~ ~ ~ u II ~ ..~ ~ ~\ ~ ~ "~ ~ ~, :.~ ! ~ ~ 1 ~ ~ S70J wA,N- CITY OF SPRINGFIELD, OREGON . . , 225 FIITH STREIT. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 CitY Job Number ~f~/o-oo ~'l'l ,70J'? {Mcdvt ~f- 1702 J1l{L( ?f~ ()~, 'l717fJ Tax Lot C~i'O() Job Location Owner of Property "'" free j"t- !et Mrf Address c:: BII ~ City ~lA ~!l:..A- :) 7 c-l$ Phon" ST (...4 <1 rS-O I State Zip .;:,', Address Phon'" City State Zip Construction Contractors License # Expireo Description .q ~~ 0/011 ~ fb V T0t ~ (f) f- Date of Installation 17.--1 I () /1 0 Date of Removal / 2;/ ~/( 0 r /. 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 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 inspectio 0 verify the removal of the banner(s) and/or portable sign(s). This inspection will begin the proce to re the 100.00 deposit ifthe"banner(s) and/or portable sign(s) h en removed. Issued By o ~q Amount Collected Ilj- Job # Receipt # Shared Drive (T:)lBuilding FormsIBanner _Po~le Sign Pennit CSD 7-01t.doe ;. '. I SP~ING.F~.~ ~!.- ~';;: ~ A OREGON www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00894 5703 MAl N ST CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 permitcenter@ci,springfield.or.us RECORD NO: 811-SPR2010-00894 DATE: 12/15/2010 """ iT'" ;. :-_;'::};~0i,,'4'-'~~Q(;_OtJNECJiDl;i;~-t'-f-i,;};AM5JJ]tJ)jJE " 224-00000-425602 $100.00 100-00000-425605 $5.00 224-00000-426605 $10.00 ---_._------~------ TOTAL DUE: $115.00 LPAYMENT-'WPE,,""'PAYOR'~':CASHiERD80WLS'li":;':C.QMMEr{ts~iL::""_ . '.0 -', 'AM9_U~1.P~ID '~.:._:..:J RECEIPT NO: 2010001048 [QESCRIP1lL@.'..'-;/'--::7 Banner, Port~le Technologx fe~ (5% of permit total) Admin Ie~J1 0% of applica~e fees) . - -~1 Check 2778 bos fireworks trees $115.00 $115.00