HomeMy WebLinkAboutPermit Signage 2011-6-17
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225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
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City
State
Zip
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Construction Contractors License #
Expirro
Description ~ R:;:/h r' cS7y /f../
Date of Installation ~// i(} /
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Dat~ of Removal 1 II if / Ir
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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),has been removed.' 0.
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Date of Application ~/Itj//I Job # 5/1-01'13 b Receipt # ZCI/ -IbiS""
Issued By . cc- Amount Collected ? 'Z-S -
Shared Drive (T:)lBuilding FormslBanncr]ortable'Sign Permit CSD 7-QS.doc
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.OLUS
811-8PR2011-01436
6684 MAIN 8T
permitcenter@cLspringfield.or.us
RECEIPT NO: 2011001615
lbESCRI~liION' ;~1!' '1'c":", ; i, ",
Admin fee (10% of applicable fees)
Banner, Portable
Banner, Portable Deposit
Technology fee (5% of ,permit total)
RECORD NO: 811-SPR2011-01436
DATE: 06/14/2011
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, ;ACCOUN:'tCOPE ' , ',: !iI,' ,,6.MOUNTcDUE fi
224-00000-426605 20,00
224-00000-425602 100,00
821-00000-215500 100,00
100-00000-425605 5,00
TOTAL DUE: 225.00
;C6MM~rfES'"j1/: ". .e' ",LL;;>:':jr.iY,lL:':t",' ,!t'~{AMci(JNTF)Anr';:";"i:~'
225.00
r PAVNlENTTYPE
Check
6886
1"
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PAVOR 'i~" ,"CA':'-t:UE'R:CC'AR'PEN'TER':
Oregon Horse Center
TOTAL PAID:
225.00