HomeMy WebLinkAboutPermit Signage 2011-2-25
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SPRINGFIELD
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CITY OF SPRINGFIELD, OREGON
225 FII11l ~'1'REET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . fAX: (541)726-3689
ctPit2.01/-00 30~
City Job Number ..>
/U;tm 5)-
Job Location
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Assessors Map
Owner
Tax Lot
Owner of Property r>,a.~'L)( -Crt i(L()u...A VL D
Address 33 S t 12.cSEW'LO.....+- LJ y
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Zip
77({O(
State
C!HJ!r!!ctor/lnstaJ!er
Con'tractor
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Address
Phon"
City
Zip
State
Construction Contractors License #
Expire<
~v\""t:"'- / Pffr7 5
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Date of Installation -z) s- It f
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Description
2h )/11
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Date of Removal
Permit Fee: $
eposit and applicable fees.
mcluding $
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 wiil forfeit the $100.00 deposit:' I also undersiand.thatthis 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 inspection will begin the process to return the $100.00 deposit if the banner(s) and/or
portable signc;>1as been removed.
Signaturp ! ~W~ ~ufiY~ Date ?--/z.~JI
For Office Use
Job# S//-o030<=t
Date of Application
zh )'/1/
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Amount Collected
Receipt # '2011- '3S~
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Issued By
Shared Drive (T:)lBuilding FormslBanner]ortable Sign Permit CSD 7-08.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-SPR2011-00309
774 MAIN ST
permitcenter@ci,springfield.or.us
RECEIPT NO: 2011000359 RECORD NO: 811-SPR2011-00309 DATE: 02/25/2011
lDESCRI~TION~ ".:':3~,,~2L:~::':' f .'..."J'/::'::'::::"""'.'32':; '. ,'~'.'.ACCOlJNt-<:6DE:~.~-,::...c~:":AMOlJNT,DUE~.~-,....J
__ Admin fee (10% of applicable fees) .-3.?4-00000:426605 .______.~O___ ___
Banner, Portable 224-00000-425602 100.00
Technology fee (5% ~,permil lotal) 100-00000-425605 5.00
TOTAL DUE: 115.00
r;"PAYMEN-fWPE" """,,,~'f>AYOR'~.'CA~~IER:-DBowLSByl:;'...:,!G';:f:L:4.QMME~f~!,\f-J1i ,":: ;~, _-. ",.:":AI'JIO_UNIPAID",,--~----,---cJ
Credit Card richard proulx 115.00
02522d
TOTAL PAID:
115.00