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HomeMy WebLinkAboutPermit Signage 2011-6-7 '\. ~- , . ~(}.:>~_ -~-ol:i-")3,'%;.-~~...,.,$---'"""", :t.-",~ _' ~ ~ 11,>. '"..",,;:;,..c-1-, -,:: ~.~~-. -', '''''=,i~,' ~"".., ", "h~ 0i:' i':;'f"j~"'2., '~;:'@FTIY-;0F,'SRR;IN@FlETIID?!OREGON~':{r';;:' "','>.:I;, "'-'-4~~>",~~~< ,~",3.>~~(f-Ijf'~~~-t:!"'~-'~4"~:l' :$:;(;; .'''-K.~.~~"?,,.~lt_:a 'Jii)ol:"-~~;.'<.;~,..l.~~ >;. "'"' 225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ~ '~ it: Job Location ~ Assessors Map ~t I; '" Owner of Property "Aj ~ ..~ ~ " ~ ContractorlInstaller ~ Address ~ City ~ Tf./!11 ~ rJ!lo., Description g ..."rIm"""". o ~ '~J ~ ............ ~J ~ ~ ~ d ~ ~~ ............ Date of Application a" "....By ..~ ~ ~ City Job Number SI (-0 IsZ/ 1/1'1 iMl~"J hojJ 3;;lio 170 ZZZO Tax Lot ~ DZl..tlQ ,3 e>! 11- fJr-.lm-> n7l<- Address 3/7 C; 91?-rf0Lu j City -5' IlPL./;/ r geJ/2- - ~O(? Phone J:CI/ - 7 z.4, -r", z.Z I {)71-- State Phone Zip 77<177 . <;;tate Zip Construction Contractors License # Alf A 11;i~ S/zi>" c- P' &/1/// Expires Date of Removal $202.00 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 display will be removed within fourteen (14) days from the date listed as the date of installation above. If the display 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 once per calendar year per development area. 1 also agree to call the inspection line at 726-3769 by the end of the 14th day to request an inspection to verify the removal of the display. This inspection will begin the process to return the $100.00 deposit if the display has been removed. Signature ~~A . Date ~A;// For Office Use Job# SlI- 0/ s: z- r Receipt# Zo II - / tf b 7 2=2- b ~!:S Amount Collected Shared Drive(f:}lBuilding FormsIBlimp_Pennants_Balloons 7...{l8.doc .~;;. \. SP~~~~E~ .~EGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 51 Springfield.OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-01321 1174 GATEWAY LOOP perm itcenler@ci.springfietd.or.us RECEIPT NO: 2011001467 [DESCRipTION ___ ~.. Admin fee (10%.?f applicable fees) Blimp, Balloon, Searchlight Blimp, Balloon, Searchlight Deposit Technology fee (5% of permit total) RECORD NO: 811-SPR2011-01321 DATE: 06/07/2011 ..-=--_ ~_ :-.._ . __.~Acc:buNTC.ODE~~~~~__AMOUNtDUE~-~_":' 224-00000-426605 18.00 ---.,' 224-00000-425602 80.00 821-00000-215500 100.00 100-00000-425605 4.00 TOTAL DUE: 202.00 ., . '_:: . AMOUNTPAID' Le"AVMENTTYPE'\ '. Credit Card 04104p . PAVOR. CASHIER, DBOWLSBY- michael schwartz ''':^< " C-OM~EN:rS refund deposit to: michael schwartz 3194 gateway loop, springfield or 97477 202.00 TOTAL PAID: 202.00