HomeMy WebLinkAboutPermit Signage 2011-5-25
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CITY OF SPRINGFIELD, OREGON
225 fllTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
SPRINGFIELD
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City Job Number
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Job Location
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Assessors Map
Tax Lot
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Address
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City
State
Zip
Construction Contractors License #
Expire.
Description ~w"""- >--^---
Date ofInstallation '514 1. , \ \ Date of Removal ~! ~ 3/1;/ \
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 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) s been removed
Datp )' ~:2. (-V/I
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For Office Use
Job # 5/1- 0 (/ f't(
Issued By
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Amount Collected
Receipt # ;20(/- /3ZC(
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Shared Drive (T:)lBuilding FonnsIBanner]onable Sign Permit eSD 7-08.doc
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www.ci.springfiefd.or.us
TRANSACTION RECEIPT
811-SPR2011-01184
5755 MAIN ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
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.'ACCOUNECODE
224.00000.426605
224-00000-425602
821-00000-215500
100-00000-425605
TOTAL DUE:
DATE: OS/26/2011
, AMOiJNT_D,iJE
20,00
100,00
100,00
5,00
225,00
AMOUNT PAID
225.00
RECEIPT NO: 2011001324
lOESCRIP.JION
Admin fee (10% of applicable fees)
Banner, Portable
. Banner, Portable Deposit
Technolo.gy fee (5% of permit total)
RECORD NO: 811-SPR2011,01184
L~AY.MENLTIP'E~:U-_f'AY-Q~~HIER:' liBOWL~BY
Check albertsons
919
COM.N1eN_T.S_ "1;'
refund to: albertsons 5755 main
st, springfield or 97478
TOTAL PAID:
225.00