HomeMy WebLinkAboutPermit Signage 2011-5-16
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225 FIITH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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City
State
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Construction Contractors License #
Expire"
Date of Removal
Permit Fee:..JZZ5:otriiiCludi~g $100.00 Deposit and applica Ie 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 sign(s) h e oved.
Date of Application
Job # s.l1-C:J~ g:?Z
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Receipt#Zol! I f
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Issued By
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Amount Collected
Shared Drive (T:)IBuilding FormslBaIlIlCi_Portable Sign Permit CSD 7-08.doc
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"^~A. OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-5PR2011-00832
152 MAIN 5T
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000969 RECORD NO: 811-SPR2011-00832 DATE: 05/16/2011
[DESCRIP...TION ' '., <:;c;5r:~'l;;;"J;. ,~.;;r,:,'~!;YF;;;Il;'A'''" ,i.l;C.CO(jNT~CODE!"';"';'''';;:';~1'';';AivlOUNT:buE,---';f:~..J
Admin fee (10% of applicable fees) 224-00000-426605 10.00
Banner, Portable 224-00000-425602 100.00
Technology fee (5% of permit total) 100-00000-425605 _ _ __ _m 5.00
TOTAL DUE: 115.00
t.J~~YMEN:t-T.YPE-,'. ,j'A YOR;-'.CASHIE'<:DB'QWLSBY r,.j;">tCOMNlEN:(Sf:"";~tr:: ,:j',; ; '. :"r.'ANlOlJNTPAiO ,';~;;;-.-J
Cash southern oregon alternative 115.00
medicine
TOTAL PAID:
115.00