HomeMy WebLinkAboutPermit Signage 2011-2-25
225 FIITH STREIT. SPRINGFIELD, OR 97477 . 'pH:(541)726-3753 . FAX: (541)726-3689
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1,4 Date of Application --::1::,""
Issued By #-
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Description '!SA-Nil/bY/.. / -f'{1rC- ~
Date of Installation "Z-)~ )( Date of Removal z/z sill
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/ I)' Permit Fee: ~25:0~ing $~~it 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 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
p~rtable si~as been rem~
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Receipt # eOl 1'::'35'8
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Amount Collected
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 81
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00310
551 W CENTENNIAL BLVD
permitcenler@ci.springfreld.or.us
RECEIPT NO: 2011000358 RECORD NO: 811-SPR2011-00310 DATE: 02/25/2011
!DESCRIe.TION.:....:....',:, . '~--' -',">>/",'j;,:n ",",:,'j "" 'gt:,~?;?;f;'=I.\C:COUNJ;CODE'?~""',';f;iAMOUNJ_I5LiE " '
Admin fee (10% of applicable fees) 224-00000-426605 10,00
Banner, Portable 224-00000-425602 100,00
__Tech!2ology fee (5!~of permit total) 100-00000-425605 5,00
TOTAL DUE: 115,00
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Credit Card richard proulx 115.00
02522d
TOTAL PAID:
115,00