HomeMy WebLinkAboutPermit Signage 2011-5-31
ZZ5 FIITH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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Construction Contractors License #
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Description pl:)(Ci'I\Ii\CG
Date of Installation ~~ 11. 1\ \ \
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Date of Removal
(,) 1.\11 t
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 ofthe banner(s) and/or portable
sign(s). This inspection will begin ~e,pr~s to return the $100.00 deposit if the banner(s) and/or
portable sign(s) has'beeif~~~.ved:- ~
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Date
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Date of Application
Receipt # ZoO - n (,7
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Job #
Issued By
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Amount Collected
Shared Drive (T:)lBuilding Forms/Banner_Portable Sign Permit CSD 7-08.doc
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 8t
Springfield,OR 97477
541~726-3753
www.ci.springfield.or.us
811-5PR2011-01226
28 W Q 5T F
permilcenter@ci.springfield.Of.US
RECEIPT NO: 2011001367
lDESCRIP..TION:c___-.-:.:~__:..:..
Admin fee (10% of applicable fees)
Banner, Portable
Banner, Portable Deposit
Technology fee (5% of permit total)
RECORD NO: 811-SPR2011-01226 DATE: 05/31/2011
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224-00000-426605 20.00
224-00000-425602 100.00
821-00000-215500 100.00
100-00000-425605 5.00
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TOTAL DUE: 225.00
, ", AMOUNT PAID: _
225.00
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L...P.Aj:I\II~I'H._IYP.I:~AY.Oi:l '.CASHII€id,S'OWLSBY.
Check robert tlmmons
29303
refun deposit to: Robert Timmons
28 W Q Street, Springfield OR
TOTAL PAID:
225.00