HomeMy WebLinkAboutPermit Signage 2011-1-19 (2)
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From:~MC
541 485 7000
01/20/2011 14:11
#422 P.002/002
JAN.19.2011 15;31 541 868 3009
LIBBRTY TAX SERVICE
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City Joh Number
Job Location -51lJ' C\ G ~~ \;J-,., ~\
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Tax Lot
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C'.on1rnctorlInstaller
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Expires
Con!lbuction Contractors Lic~D8C II
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Description
$202.00 including $100.00 I)epl>8it IIlIll applic:lble f('.es.
By signature, 1 state and awee lbat I have carefully completed this llpplication and hereby certifY that aU
information herein ;s true and corr~cL I further a~ and understand lbat the above described display will be
removed within fourWen (14) days from the date 1i~1ed as the date of ins lallation above, !fthe display is not
removed within the timeline specifil'd, J will forfeit lbe $100.00 deposit. I also understand that Ihis special
penuit can Dnly he ;,.sue<t twice per cat""dM year per development orea. 1 also agree to call the Inspection lim, al
726.-3769 by the end ofthc 14'" day to request an inspection to verify the removal of the display. This inspeclion
will begin the praccs.o to return lhe $1 00.00 dep"~;t ift1,e display has been removed.
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For &mce Use
Date of Application
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511'00/Cz.
R"""ipt#
1011#
202-
Amount Collected
Issued By
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SPRINGFIELD
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':: OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth $1
Springfield,OR 97477
541-726-3753
www.ci.springfield.Or.us
811-SPR2011-00102
3169 GATEWAY ST
permitcenler@ci.springfield.or.us
RECEIPT NO: 2011000141 RECORD NO: 811-SPR2011-00102 DATE: 01/21/2011
EDEscRi~TIt:fN(~Sf'4'"" :":~~,~~'-:~",:~"ff~:Iijiqrg;~'~:,:,::~!Ll.:~'J::',~ ":'Ac.c_6XiNT~cbDE f';'f':;r .i. ;';~'<~~AM()U~NT~D.UEt~.~'''' . ,,",rei" ; i
Admin fee (10% of applicable.!ees) 224-00000-426605 ____ .___ 18.00
Blimp, Balloon, Search~~~._ 224-:'l_~~0-4256_03.,__,_____.._____,~;~_____
__~p, Ballo~.'.~earchlijl,'l!"Deposit __~__ 821:00000-215500 ._____~._______.._..l~~0__ ___
Tech~olo!lY fee152" of permit total) __,__ 100-.90000-42560~____,__-- __ _ __ _ _ 4.:2CJ
TOTAL DUE: 202.00
1':PAVMENj:;IVE.E:c;"1::J?AY..9.B"f ,;;d~!'iHIER' blj,o.!"liSB~c~C_QMililj;'NI$~; :~i.,t,:;~'f--~";:.'--: A.M.QUN.cT~PAlb;~," " ".:~
Check tc tax services Jle refund to: tc tax services 3169 $202.00
296 gateway st springfield or 97477
TOTAL PAID:
$202.00