HomeMy WebLinkAboutPermit Signage 2011-4-28
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225 FIlTH STREET. SPRINGFIEW, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
City Job Number
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Construction Contractors License #
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Description ~(\ 'f\'f\p ~
Date ofInstallation-y-1 z- '1 f II
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Date of Removal
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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 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 si@(s) has bee rem ed.
Date of Application Lf.
Issued By
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Amount Collected
Shared Drive (T:)lBwlding FormslBanner ]ortable Sign Permit eSD 7-08.doc
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TRANSACTION RECEIPT
CITY or SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00719
4343 MAIN ST. STE A
permitcenter@ci.springfield.or.us
RECORD NO: 811-SPR2011-00719 DATE: 04/29/2011
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224-00000-426605 20.00
224-00000-425602 100.00
821-00000.215500 100.00
100-00000-425605 5.00
TOTAL DUE: 225.00
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Check mckenzie feed and saddlery refund deposit to: mckenzie feed 225.00
206581 and saddlery 4343 main st,
RECEIPT NO: 2011000842
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Admin fee (10% of applicable fees)
Banner, Portable
Banner, Portable Deposit
Technology fee (5% of permit total)
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TOTAL PAID:
225.00