HomeMy WebLinkAboutPermit Signage 2011-2-25
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
~ 1/_ O~ sl/
..~ City Job Number SPA.. 'Z.C
..~ Job Location ItpS7 Moh4-v1d<
..~ Assessors Map I 70] z S :5 (
Q
~J
~
~
..~ Address
~ City
~
~
"~
!
I
,~
,.. """_"'.Jt.
II
I. '.
..~
~
F'" !4
~
~)
"~
~
~
~
!
(Q>
~
1
~
M
(Obe' III I A~c..(!"
((:J/II"Y'"
SPRINGFIELD
~0'\!":~W'" .
~"ii~::':<-, ,,' ~ ~
, ,'. ~.~, ". Qj)
" , CITY OF SPRINGFIELD; OREGpN';' ':. ",',:
B)vo!
Tax Lot
05goo
r-q;,;;J~:, ,': f;~~~b[;I:]:f;,:f:;'~];;tl:;.:-::~~f,I~;-,,;,!ti:: ~~~i;,j;'i::::;;:~::/~"L'j: ~ "':;E::~ ",:: "
Owner of Property ;04"1.1I1\1\.e<L \)r~+Vt~' L.LL
PO 1?OX Z2bb
c.-v.- (,-WE
Phone
State
(joR-
97'102.
Zip
I'c~nj~e~~~rlf~~i1lj~~:,~;f~~5~~::;~,ii~~~.~:~f~;~c~rl;[~:;i'~[;;;:~!{,~~~~l:~-' :~JJ~;Y":"'~~':~"
Contractor ' OW I~C e, ,
Address
Phon"
City
State '
Zip
Construction Contractors License #
Expire.
Description "7lA-AlNr=tL /fL~~
Date of Installation 2ft 5" 11/ Date of Removal 2/2 S' /,'
~ / ' I I
! /$ Permit Fee:$2~_s.{)oin:luding $!9-0060Deposit 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 $100.00 deposit if the banner(s) and/or
portable sign(s) has been removed,
Signatur" ~ Q~ Dat" ~ft);jl
[-~;--:';"" .::K .~~. ,:"T~~:':, .~:':':'-" ,F,or."Oliiifciil~~,:,:/f5:~:'-----;'J- ;-- ',-'-~;~~ ,':-,- ,:~;-,: '
, ~ate of ~p-p;ic~t::---21i-~~'---~~ob # s/7:o'6-Y; /r ~;ecei-p;~?OjT- -3 bT'
/ I
"":b t.1 Amount Collected ) I S" -
Issued By
Sbared Drive (T:Y'Building F~]~le Sign Permit eso 7-08.doc
1
..; "'-..
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00311
1657 MOHAWK BLVD
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permitcenler@cLspringfield.or,us
224-00000-426605
224-00000-425602
100.00000-425605
TOTAL DUE:
f$t,;PAYlVfENTTYWE."~t,,~1,~.~PAYOR~':CASHiER:;DBOWLS~BYL'ii.~(.:t.~:~" :C6MJ~f~~T~;;$'ir.,.~~' ,~~ ~:~~ ;"0;0 ,~t{
Credit Card richard proulx
02518d
RECEIPT NO: 2011000361
{DESCRIIH/ON..: ~'*" · --",co _::..:'~;,'
Admin fee (10% of applicable fees)
Banner, Portable
Technology fee (5% of permit total)
RECORD NO: 811.SPR2011.00311 DATE: 02/25/2011
ff . ~,:_, "'.~ ",,"ACCOUNt:CODEG-;-.L&':::::.'.'t::-./iJIIIOUNT.DUE.;.':.":.'. j
10.00
100.00
_ _~_"_w_
5.00
115.00
AMOUNT PAID
115.00 .
~
TOTAL PAID:
115.00