HomeMy WebLinkAboutPermit Signage 2011-1-19
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01/20/2011 14:10
#422 P,D01/D02
1){Q~ _I QJfLIBERTY TAX SERVICE
JAN.19.2D11 15:30 511 868 3009
'0267 P.001 /002
225 ru'HI ~TRO:r . SPRlI'i!GI1I:LD, OR 'J7477 . l'H:(Ml)7Z6-8753 . TAX: (S41)726-~G85
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" Description ~v-.. {\ 'f'---J>-L \=)0 ( ~ \d ^........"::)\ (~
.. ~ Date of Installation I. d'-f' \ I Date ofRemovnl ;::). d- I I ,
~ Pel"mit Fee: $225.00 indudin" $100.00 Deposit and applicable fL'(OS.
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~ By signature, J state and a,,-ec that I have carefully completed this application and moreby certify that
all infOlmation herein is true and emmet. I further agree and understand that thc above deScnocd
t=l. baDn.cr(s) and/or portable sign(s) is not larger than 60 square feet, and will be removed withiil30 days
..~ from the date listed above. Iftlle bllIlIler(s) and/or portable sign is DthotremOved within the timeline
~ specified,. I will forfeit the $] 00.00 deposit. I also understand that is special pennit c:;m be issued
only twice per calendar year per develupment area. I a150 agree to call the in:lpection line at 726-3769
..,$! by the end of the 30th day to request an inspection to verify the removal of the banner(s) and/OT portable
~ sign(s). This in:ipeCtion will begin the process to return the $100.00 deposit iftbe banner(s) and/or
.~ portable sign(s) has been removed. ~~"- ~. . .
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- Issued By ~'j Amount CollcC1ed ZZS:-
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Tax Lot 0 "5/(,:)U
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Address
Phone
City
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Zip
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Cunstruction Contractors License #
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00101
3169 GATEWAY ST
permilcenter@ci.springfield.or.us
224-00000-426605
224-00000-425602
821-00000-215500
100-00000-425605
TOTAL DUE:
LJ:'AYIVIEl'lf tYE'gS:~c,f'1AYQRf;f;:c':}'ASHIER,.D,,6w':SBY' ~t0~cbMMElmL:=_;!;- < '''. ~
Check tc tax services Hc refund to: tc tax services 3169
296 galeway sl springfield or 97477
RECEIPT NO: 2011000142
IDESCRIi>:tlt:lN t'~-L:~:_L_~;~'t:??:<'::
Admin fee (10% of applicable fees)
Banner, Portable
Banner, Portable Deposit
_T~I~~x!ee (5% of permit total)
RECORD NO: 811-SPR2011-00101 DATE: 01/21/2011
;,:~;:;- ):i~.:; ;....J;;;J;;,i\.c:cbUNf~cODEVy:::<' ~ ';""f lAM0UNT;DUE"':;"
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20.00
100.00
100.00
5.00
225.00
.. AMOUNT'PAID'" ., . I
"._._~_. .-..--. ----.',~,~~%,-~--,--,_..._,
$225.00
TOTAL PAID:
$225.00
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