HomeMy WebLinkAboutPermit Signage 2011-4-19
225 FIITH STREET. SPRINGFIELD, OR 97477 . PJ-I:(541)726-3753 . FAX: (541)726-3689
=
..~
"~
~
"~
Q Owner
~J
..~ Owner of Property
t
~
~
~
"~
~
UJ Description~(1)(\ -Nll<on SCope." \,Ijjth 'o\111W_G orts on~(d
~ s ( f\ot aIrborn
..$!!!~ Date ofInstallation May fdOl1 Datf of Removal MO..-\! t)? I C::>DJ I -J
a. -b())\f In Ute (If, p-omot-rcn CAW-1M QRaci1 OP<2/\i1\Cl WU\<,e,(\Ov
~ ~ ZOz.. ~ermit Fee: ~ including $100.00 Deposit' alid applicable fe~~..:.J
~ 0 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 If{ d"r 5
~ banner(s) and/or portable sign(s) is not larger than 60 square feet, and will be removed within 30 da]~
. from the date listed above. If the banner(s) and/or portable sign is not removed within the timeline
'. % ~pecified, I will forfeit the $100.00 deposit. I also understand that this special permit can be issued
~nlY twice per calendar year per development area. I also agree to call the inspection line at 726.3769
y the end ofthe~y to request an inspection to verify the removal of the banner(s) and/or portable
- ignes). This inspectIon will begin the process to return the $100.00 deposit if the banner(s) and/or
~-n portable sign~s)rras been removed. "
\='ignatur.p ~2i:1 [jp JJ tf Dat" tfj ;q/::JO/ /
~ / / For Office Use
- ~'" of AWlk"'". 'f! z r" Job # ;;?fC 0 D 71 "3
~ ~ Issued By ~'.!. Amount Collected
,
City Job Number S{)IL201 r - 00 7 ( 'J
Job Location ~~nD ~(}tt\JJa~~+. i Sp-iIl1~
Assessors Map~ 70 5> Z 200 Tax Lot
cnm
o Z--'0{
C~Ia.'5
~
Addressd-~()() hn tp \~)Q\f--U rp fI.f
City (:~)(:ln9fuld
Cabela's
PhoDP 3L[J- ~Lf9~5/(d) ~~
State~Zip qi4-1t
Contractor/Insta/ler
Contractor Uslm ~{, SAJes A3e.n tY (owner of btUoo,.;')
Address d51J \JQ.r-wid< ~xfde....
J+-\-lan..m
Phon
City
bA
303i-5
Zip
State
Construction Contractors License # ~
Expire.
Receipt#1'ot/- S3l{
2DZ
Shared Drive (T:)/Building Fonn~er]ortable Sign Pennit CSD 7-OS,doc
<.
"
sp. RIN..GFIE~.
.~
.~.' ~
~, ~'OREGON
TRANSACTION RECEIPT
811-SPR2011-00713
2800 GA TEWA Y ST
www.ci.springfield.or.us
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
pennilcenter@ci,springfield.or.us
RECEIPT NO: 2011000834
lDESCRIP.TION____.- ':'0;;,'
___ Admin fee .J2.O% of applicable fees)
Blimp, Balloon, Searchlight
Blimp, Balloon, Searchlight Deposit
Technology fee (5% of permit total)
RECORD NO: 811-SPR2011-00713
._-':"~:...:-..f:....ACCOUI'iT,.CODE:
224-00000-426605
224-00000-425602
821-00000-215500
1 00-00000-425605
TOTAL DUE:
COMMl:lfTS ",0.,_. ,....
refund deposit to: Leslea Heidel
w/Odle sales Agency 2577
UAYM!;~lTYPE'"
Credit Card
01 963z
PAYOR" CASHiER:.DBOWLSBY"-1~ i,
leslea heidel
DATE: 04/29/2011
!" AMOUNT_DUE-------'--'..:..:J
18.00
80.00
- - ------
100.00
4.00
----------_...~
202.00
AMOUNT PAID
202.00
.1
TOTAL PAID:
202.00