HomeMy WebLinkAboutPermit Signage 2011-5-10
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225 I1ITH STREET 0 SPRINGFIELD, OR 97477 0 PH:(541)726-3753 o FAX: (541)726-3689
City Job Number
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-3 19':1 ~A(l3w~
/7032220
Job Location
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Tax Lot
Owner
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Contractor
Address
Phon..
City
State
Zip
Construction Contractors License # Expire<
Description f- /}tJrhtb~ - //--/}A7z..-e - ~1/L$
Date of Installation r () -:1 tJ - f / . Date of Removal t;., - 9 ~ / (
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 notlarger 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) h een removed.
Si
Datp /-/[)-II
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Date of Application
Job # >//-oD78-6,
Receipt # 2'0(/-07/ z..
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Issued By
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Amount Collected
Shared Drive (T:)fBuilding FormslBanner_Portable Sign Permit CSD 7-08.doc
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth SI
Springfield,OR 97477
541-726.3753
www_ci,springfield,or.us
811-SPR2011-00786
3194 GATEWAY LOOP
permitcenter@ci.springfield,or,us
RECEIPT NO: 2011000912 RECORD NO: 811-SPR2011-00786 DATE: 05/10/2011
lDESCRJrJ.TIONR"Scr:: ~'":" '.- -:;';_''''-''\)0;1 ;;~<f'#,--_i~';:i,f":;~-~+wjAcC0UNf:t;(rDE;~~/ --;";;;.:L'AM()UNT"DUE~:',..::f':l
Admin fee (10% of applicable fees) 224-00000-426605 20.00
Banner, Portable 224-00000-425602 100.00
Banner, Portable Deposit 821-00000-215500 100.00
Technology fee (5% of permit total) 100-00000-425605 5.00
TOTAL DUE: 225.00
LP.AYMENJJYP-E ~-,,,c':.P.:4Y..9R~si~jH'-Ei"DBOWLSBJ~'*;_ ri;--;:':;:-.C::QMMENJ~'..,:".;- ~ .~.~~ _7"'-;'-AM()UN]J~AIJ[1.'~' ~': -. 1
Credit Card michael schwartz refund depositto: michael 225.00
_027.81p __ .____________________s_c~wartz 3194 gateway Ip,
TOTAL PAID:
225_00
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