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HomeMy WebLinkAboutPermit Signage 2011-5-10 .~ i."'" ~ (Q; "~ r:@.l .",~~ ~ -.. .__J~ Q ~..l ..~ ~ ~ ~ ~ ~ ~ "~ S ~~ ..-4 ~ e.~ U Ii I, '. ..~ c: ~ ~~ ~. ~J -.. '....--'~ ~ ~ 1 ~ ~ ~ ~ i (G:Q >-~~~~,;;';;~<~-;. hI;p~i 0" F;;S"p'D'ThT~D"lE"L'DI 'O~RE' 'G" D.i:T~:) :~.]'t.:; ~ .<~ ',e-,Y:- r R ""-::~ Jl..rL" ..l'\!-'l"l~1: -' ' , _~ Ul'\l[rJJ,"j"..J>,.W z." _ .~'f:.t~. ~"~",-'"'<<_.4". ,.l_7J..t...;--,..~~~....,''''''' .,.,'t;'~-".~.~' ..~'il'<f fJ'..,j1'4" .~'~_-et*"'<>'..,v' 225 I1ITH STREET 0 SPRINGFIELD, OR 97477 0 PH:(541)726-3753 o FAX: (541)726-3689 City Job Number S.p1L2J~ l{ - (SO 75 b -3 19':1 ~A(l3w~ /7032220 Job Location ~;:? D2-S"C{ Assessors Map Tax Lot Owner :::.~;~ r;:;:~/ ~:: {~"' :'/ 7~;?z / , oft" ~~'" .,.... ""'" ",-... ,"- ."~ """,0,' +""""-+'0'"''~._~'''''-ri,J\''-'''''jmj"""~'",,,,'''''''''''~''''''''''''' ?-".~.'t/'<r-- ..]t-'G8'F';"""''"-YJ~r''~'fl'"'~S''~rv~--''"''' "~'f;"""j;'''''''''''o/''''~'' '-''''''.'It.-'''"'Tr:-.y;jf.<.,y~.. ", .'Y'I(. ifI!."'~1' t~q~~t~~i~l~~i;ditl~l{~~~f~~s~~~~~;~;'~t~~~~~f~i;iifar~~~~l4zt;~~~~~i;~;~i~J{~i~'~:iri~~:fh~f:-'!~rK~~~~~ 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 - Date of Application Job # >//-oD78-6, Receipt # 2'0(/-07/ z.. 2'Z ~ ~ Issued By b~ Amount Collected Shared Drive (T:)fBuilding FormslBanner_Portable Sign Permit CSD 7-08.doc 1.r.. SP~~N~~~~ .?;(~ , :~;,-^ OREGON 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 r