HomeMy WebLinkAboutPermit Signage 2011-6-18
225 FIITH STREIT. SPRlNGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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Owner of Property 1(/'f5tTK:. fJ51'Ji,-J ED
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Date of Removal
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$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 time line specified, I wi!! forfeit the $100.00 deposit. I also understand that this special
. permit can be issued only once per calendar year per development area, I also agree to call the inspection line at
726--3769 by the end oflbe 14th day to request an inspection to verify the removal of the display, This inspection
will begin the pr cess to return the $100.00 deposit iftbe display has been removed.
Date
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For Office Use
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Shared Drive(f:YBuilcfu"g Forms/Blimp]ennants_BalIoons 7..{l8.doc
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
www.cLspringfield.or.us
811-SPR2011-01499
2251 MAIN ST
pe rmitcenter@ci.springfield,or.us
RECEIPT NO: 2011001682
rDESCRI~;rION~_ ~':..~~.~' ~:_3:___' .::"'~
_._ Admin lee (10% of appljcab~ fees)
~ Blimp..: Balloon,l,?earchlight
_~ogy fee, (5% of permit total)
RECORD NO: 811-SPR2011-01499
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224-00000-426605
224-00000-425602
100-00000-425605
TOTAL DUE:
~, -COMMENTS;+;"~~-;,,;;;<,'+
DATE: 06/20/2011
, -"'AMOU-NT,D,UE:'
800
80.00
4.00
92.00
:"AMOUNT,PAID' ...
92.00
QAYMENT'1Y~;-J':;:PA YOR. '~CAs>iIER,DBow"seY'h',F,
Check ' the little shop of hoarders
1078
TOTAL PAID:
92.00