HomeMy WebLinkAboutPermit Signage 2011-2-23
225 FIFI1I STREET. SPRINGFIEW, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
~
""~ City Job Number
".~ Job Location
"0 ~ Assessors Map
Q
~
~
.. ,~ Address
>
~
~ City
~
~
".~
~.
;;;t Address
e
~
u
II
I. '"
".~
~
~
=
~)
..~
~
~
i
~
~
~
~
I
~
~
"ii ~ (.
'?,~, , ,-;, c}nr;YoF~sPRJ..NdFIEtD.OREGON;':~ '-'~~.'" .
':~"" #t. ", ' kt.... <.~ ~" ' c"."
~~.e.~(\,L sRt'tv:>tl-OOZ "itS'
o c.. YI.N\I'~ ~
.
#c
Tax Lot O/,r-O I
?'..o?O
/7032 SLf z.
>T
~1~~~;{~~~?~~11~~i~?ii~~~~tli~1t!t1f~~E~1;~!I~~~t:~:~~~'~ji,~r~~r~~~k~~~~~~;~i~~;
Owner of Property VIA C.fC A-t C c........"'^''^-~.A- / r--r~f? 1:'+-1'i.::s
7 b. G:- L ;"Lf L {J s..fe- ~ Phon"
I
c'^-.
(..ru_ (,- bV't.
77QC (
State
Zip
Phol'P
City
State
Zip
"
Construction Contractors License #
Expirl'<
. Description
Date of Removal
1..........(.,.. ~ It:' SO, '-
cod e:'
CCJ-f'J 1.;4-c..~
-
Date of Installation
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 speciaI 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 inspection to verify the removal of the banner(s) and/or portable
sign(s). This inspection will begin the process to return the $100.00 deposit if the banner(s) and/or
portable sign(s) has been oved.
Date of Application
'~~'"''1'''-v;
'h:~,~Z~
'Receipt # 2-0" 0003'3(;,
Job #
Issued By
.II)
Amount Collected
Shared Drive (T:)l.Building FormslBanner yortable Sign Permit eSD 7-08.doc
( i'
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00285
2090 OLYMPIC ST C
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECORD NO: 811-SPR2011-00285 DATE: 02/23/2011
" "<;,,;: ,:k~~,"0'AcCO,UNT~C5bE ":";' ,,;~,"'AMOUNt,;b,UE .;. ~_',i c' '':I
224-00000-426605 10.00
224-00000-425602 100,00
100-00000-425605 5.00
TOTAL DUE: 115.00
L1eAY~''-E'iilIYe.E:,'j;;;i'';;piy(rR-''C.a~_HIER:DBOWLSBV',q;!4j": .cQMMENf$'k~5;;;,:;t. '*'!'''.:'~';,\.;S;; ijAM()Ut:lTPAID,.,,~:.: _ "',; ': "J
Check anytime fitness - springfield 115.00
1262
RECEIPT NO: 2011000336
fbESCRllftlo'N'" 'i, "', ;;"'j-~~~'I:.(;' 'l'i.r 'I;' :,,'
Admin fee (10% of applicable fees)
Banner, Portable
Technology fee (5% of permit total)
TOTAL PAID:
115.00