HomeMy WebLinkAboutPermit Signage 2011-3-21
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. CITY OF SPRINGFIELD. OREGON
225 FIITII STREIT . SPRINGFIEW, OR 97477 . PH:(541)726-3753 . rAX: (541)726-3689
SPRINGFIELD
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City Job Number .> ?Lz-o (( ~O 0 L/ b6
Job Location <19.5 \-to"u.,.&\"i ~"\\dcef
Assessors Map-! 705 2 b ( 2
Tax Lot
(')D(CJD
Owner
Owner of Property \')(3--'<\ \\.l\:A."\\-
AddressJ9.5 f. L.o~
City ~l)I\'\C}\D{\ G ~
Contrm:tor/lnstaller
Contractor Ol.:)'(\e (""
~'CpC.., i I f\C .
Phon~ I - ~'6- d-3'&
State O\<... Zi~
Address
Phonp
City
State
Zip
Construction Contractors License #
Expire<
Description A - Pro me
Date ofInstallation .fY\o.{'c ~
V()'(">";o...\o\f' / ~\~\\
I~ : dDlL DateofRemovad~{)fJ
I <6 I :;/ 011
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 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 ofthe 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 $100.00 deposit if the banner(s) and/or
portable si (s) has been rem
Signatur
Date 3 - 2\- \ \
s: '2 Zc {(
Date of Application 1'1
~
For Office Use
Job# SI/-oc:::::, 4U-
Receipt # Zo// # 525
2ZS-
Issued By
Amount Collected
Shared Drive IT:)lBuilding FonnslBanner]ortable Sign Pennil CSD 7-QS.doc
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00466
995 HAYDEN BRIDGE RD
permilcenter@ci.springfield.or.us
RECEIPT NO: 2011000525
[DESC RI~TI0N """'c:,L;;,:;;~' ;;'~;:;'f,.'ti",
Banner, Portable
Banner, Portable Deposit
Permit Fee Adjustment - A~ministrative Fee,
_..:!~chnologlf..U5%."! permit.total)
RECORD NO: 811-5PR2011-00466 DATE: 03/22/2011
:f..i;t. "i..;:';:l';;::.i.;':",;' '''ACGQtfNT.:CODE'' :\ ....c,. 'i;2"4,S,;AMOUNT.DUi::f .'50' .:' 1
224-00000-425602 100.00
821-00000-215500 200.00
224-00000-426605 20.00
----
100-00000-425605 5.00
--.---- ~-- -. ----
TOTAL DUE: 325.00
.!C~Q_~M~~~~i~r'."~';'~.E ..~.: ~ '-~. .:B::ii'.-l:~<L-":$l'AMOUNTPAlp - /z~::, it ~tM";,_~SJ
325.00
LB8YNIJ;__ijJjn:R~\7:'1J0:"~J PA V6R ~ :'.CASHIER?'6130\ft'jC:SBY~;"'€;~~>~
Check dari-mart
5116
TOTAL PAID:
325.00