HomeMy WebLinkAboutPermit Signage 2011-3-1
ZZ5 FIrm SlREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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SPRINGFIELD
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CITY OF SPRINGFIELD, OREGON
Contracto:/lnstallcT
Contractor
()WJJe"L
Address
Phone
City
State
Zip
Construction Contractors License #
Expire.
Description
Date of Installation Z;/~j/I (
Date of Removal
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 time line
specified, i will forfeit the $100.00 deposit. 1 also understand thai 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 inspection to verify the removal of the banner(s) and/or portable
sign(s). This in ection will begin the71r ce s to retu the $100.00 deposit if the banner(s) and/or
portable si ha be removed.
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Signatur~' Dale ..} 'I
Date of Application ~;i~ It
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Issued By ~
Job# S//-D 032Y
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Receipt # 7011-.s J
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Amount Collected
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Shared Drive (T:YI3uilding FormslBanner]ortable Sign Pennit CSD 7-08.doc
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www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00324
255 S A ST 1
CITY OF SPRINGFIELD
225 Fifth Sl
Springfield,OR 97477
541-726.3753
pe rmitcenler@ci.springfield,or,us
RECEIPT NO: 2011000375 RECORD NO: 811-SPR2011-00324
[.D.E.S....CiR.. 11" '1IO'N' WI,',' '''0 S>;.','O 1""'-~0t:""",.,."." .,,,W"'; '''<'A'C' 'c'o'u N'"f'C'O'D,'E,',,"'.;,;.:' -,
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Admin fee (10% of applicable fees) 224-00000-426605
Banner, Portable 224-00000-425602
Banner, Portable Deposit 821-00000-215500
Technolo~y fee (5% of permit total) 100-00000-425605
TOTAL DUE:
DATE: 03/01/2011
~- J ',:"':AMC;;lUNI;DUE',,,?S-, ;, .:1'1
20.00
100.00
100.00
5~00
225.00
LP',6.;r:MtNLtie.g~"::~YQR:,CASH1{Rr~ow!ssB,"l~:,.:' :
Check msb service centers inc
3582
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225.00
TOTAL PAID:
225.00