HomeMy WebLinkAboutPermit Signage 2011-5-23
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CITY OF SPRINGFrELD, OREGON
225 FIlTH ~'TREET . SPRINGFIELD, OR 97477 . PJ-I:(54 [)72G-3753 . PAX: (54 [)72G<~G89
City Job Number
~(>a.. eeL /-0 /Ig'Z-
3Z70 G-ATnifA.../
,
Job Location
Assessors Map-.J I () :3 Z Z "Z- 0
ozoor
Tax Lot
Owner
_~,..,rifV\_L>L.j V I I (I
Owner of Property ~_~ ~
Address ::J/75ILJ NE '-15th Sf-; J~i+c. IDLf_Phone dOlo-,3QI-d.3'15
City he..oitl~ State----1...!.1B-- Zi~g 105
Contractor/Insta//er
~2mt&f
Address 3;)''7D ("'~tel.lJ(:l~ <.c,t-.
City l 'Spr-; nghe1d
Phone-d 80- 9.a.1-/ fY) e;-
State wA Zip~ 4'7'7
Construction Contractors License #
Expire<
Description '1SA-N'df::'fL
Date of Installation ~,1 ~)f Date of Removal ~) ~/;I
Pennit 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 been reroved. }
Signature l/L~( O~~ Date rJ"if7.3/11
For Office US/!
Date of Application 5 Ii ,It I
I /
Issued By ~ (!;
5.//-0 II gZ.
Receipt # ZOII- / -:> z Z.
2-2- S- -
Job #
Amount Collected
Shared Drive (T:)/Building FomlsIBanner_PortabJe Sib>t1 Permit CSD 7.08,doc
t ..
SP~IN.GFIE~
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IIEh~EGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-01182
3270 GATEWAY ST
CITY OF SPRrNGFIELD
225 Fifth St
Springfield,OR 97477
541.726.3753
pennitce nter@ci.springfield.or.us
RECEIPT NO: 2011001322
lDESCRI~TI()N _ '"___._ ..__
Admin fee (10% of applicable fees)
Banner, Portable
Banner, Portable Deposit
Technology fee (5% of permit total)
..----.,:..
RECORO NO: 811-SPR2011.01182
- __-"-:ACCOUNT.CODE
224-00000-426605
224-00000-425602
621-00000-215500
1 00-00000-425605
TOTAL DUE:
.c'QMMENTS . .;- _
refund to: Castle Megaslore 3270
gateway st, springfield or 97477
OA TE: OS/26/2011
-AM-OUNtDUE..._~_ "~
20.00
100.00
100.00
5.00
225.00
AMOUNT PAlO J
225.00
L!:',o. YOOl:lfLTI.!:'L...c-,"-!:'.iy'QR CASHIER'NMACHAOO
Check castle megastore springfield
000006
TOTAL PAlO:
225.00