HomeMy WebLinkAboutPermit Signage 2010-12-10
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CITY OF SPRINGFIELD, OREGON .
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225 FIITH STREIT. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
CitY Job Number
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Construction Contractors License #
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Description .q ~~ 0/011 ~ fb V T0t ~ (f) f-
Date of Installation 17.--1 I () /1 0 Date of Removal / 2;/ ~/( 0
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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 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
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Amount Collected
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Job #
Receipt #
Shared Drive (T:)lBuilding FormsIBanner _Po~le Sign Pennit CSD 7-01t.doe
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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
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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)
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Check
2778
bos fireworks trees
$115.00
$115.00