HomeMy WebLinkAboutPermit Signage 2011-1-20
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
City Job Number sf(L Zen -00C> 9S""
Job Location Ie 7.3 f )~11 Ur P/~
Assessors Map 170 ~ Z b 2 '3
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0230/
Tax Lot
Owner of Property 1~ in'), k
Address '3 :~;~"3 1l!t::\..J /~J(:! ~4-~ '12-J
CityJ~ 1+.."Je> fA-A.-lc-. . State~Y
Contractor/Installer 5 ~,J-f- /61 h fill a 1-5
Address 1 ct 73 Pr F1 tel"" f tw~ ~s +
City 3PHhJ-h'-e t1 State Oft
Phone
/(oCfZ-
Zip
Phone 5Lf /' q I;;. -05CfS
0;71DI
Zip
Construction Contractors License #
Expires
Description
ba! / l/'7h
Date ofInstallation
Date of Removal
$202.00 including $100.00 Deposit and applicable fees.
By signatnre, I state and agree that I have carefully completed this application and hereby certify that all
information herein is trufr3'ltFCorrecf:) I further agree and understand that the above described display will be
removed within fourtetfn (] 4) days..fr6m the date listed as the date of installation above. ]f the display is not
removed within the time1iiieSpecified, ] will forfeit the $100.00 deposit. I also understand that this special
permit can only be issue.d twice 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 p cess to return the $]00.00 deposit if the display has been removed.
Signature
Date
I /;).0 II(
For Office Use
Date of Application
Job# Sl/--oOO ?r
R . t# 20(( ~ 0 ( '3 ,
ecelp
r..O 2.... -
Issued By
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Amount Collected
Shared Drive(T:)IBuilding FormslBlimp]ennants_Balloons 7-()8.doc
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield, OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00095
1873 PIONEER PARKWAY EAST
permilcenter@ci.springfield.or.us
RECEIPT NO: 2011000139 RECORD NO: 811-SPR2011-00095 DATE: 01/21/2011
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Admin fee (10% of applicable fees) 224-00000-426605 18,00
~mp, Balloon, Sear:~light 224-00000-425602 80,00
Blimp, Balloon, Searchlight Deposit 821-00000-215500 100,00
Technology fee (5% of permit_total) 100-00000-425605 4,00
TOTAL DUE: 202.00
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Check flight of the phoenix inc $202.00
1252
TOTAL PAID:
$202.00