HomeMy WebLinkAboutPermit Signage 2011-5-2
225 FlITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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$202,00 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 display will be
removed within fourteen (14) days from the date listed as the date of installation above. If the display is not
removed within the timeline specified, I will forfeit. the $100.00 deposit. I also understand that this special
permit can only-be issued twice per calendar year per development area. I also agree to call the inspection line at
726-3769 by the end of the 14th day to request an inspection to verify the removal ofthe display. This inspection
will begin the process to return the $100.00 deposit if the display has been removed.
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Shared Drive(T:)IBuilding Fonns/Blimp _Pennants_Balloons 7-08.doc
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
. Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-5PR2011-00723
1939 LAURA 5T
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000846
tOESCRJ p.~TfoN____" ;"~..~~ ;: ',.\.--: ';,. '. ;. ..- -
__ Admin fee (10% of applicable fees)
Blimp, Balloon, Se~chlight __.
Technology fee (5% of permit total)
RECORD NO: 811-SPR2011-00723
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ACCOUNT-CODE'
224.00000-426605
224.00000-425602
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100-00000-425605
TOTAL DUE:
DATE: 05/02/2011
,'.i>....MOUNT.DUE 'I
8,00
80,00
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PAYMENT TYPE
Credit Card
04586c
'PAYOR', -CASHIER, NMACHAOO'
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, 'COMMENTS
4,00
92,00
AMOUNT PAID -=-.J
92,00
marge buster
TOTAL PAID:
92.00