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HomeMy WebLinkAboutPermit Signage 2011-6-24 ZZ5 FIITH STREET. SPRINGFIELD, OR 9.7477 . PH:(541)726-3753 . FAX: (541)726-3689 lj!!.) ..~ e ~ Assessors Map ~l l~ ~ ~ ..~ :a ~ ~ ~ City rtI11 --....... ~ ~l Date of InstaUation ~ ~ ~4 ~ ~ ~ -....: ~ l~ ~ i ~ ~ -..........:: Date of Application ~ e Issued By "~ ~ m J -' 'It''' .. :;~~..~ , ~'H ~, ',ri> ~ .. ......."", ~- ...~,h... "t", I.', .,"". .,~. J..{"~' .. "'ifi!'- ~!\f'~':i;'r:-'" ~'l" -""~F ......,.~ ~",,, ..R~.- -. ~". ,'- "''''~ ""'~~....-.. ~..~ ..'.f'<- i9 "'" . '.ill; ~!~~~;';k\~61r;y;~OF'SRRm6FiIEl!f)'~GRE@ON[';~~-~.,'!..:;,.,:,~/.' ~~,l_~~.;'~b:'t..::-,; J """ _ ~%1!l; ::.r~.?f_~,~~;tll'i...~'-, ~ ~: -'L" .~~~"Ti!-~.h,''>.';r..~>",-v:i-~~t ::~~~-~':"''2 City Job Number Sf 1- 0/570 Job Location II &;;L haJeiV<1...'j- 17032ZZ0 SiJF/d , , rrt2- . , 97l./71 o z. 'iD L( Lp Tax Lot Owner of Property '5+,0..+"); I1j_~f"h ;f-uye j ~6.U.to.. SVtluCO.x+z.. Address -.ZJqLj ~/lJC'-UJa.(J- l.p Phone .()'q)ru_& -10:;";;'1 City~""'\.J+?dJ , State (11? Zip Cj 1lf1J'7 Contractor/Installer ~ f 6 'Address '7l1QLj ~<<.;!eWCl.:J 5pn '0 H eJot Lr ~q~) rzZr , ~ 22/ 07'ft1 Phone State ~ Zip Construction Contractors License # Description ~ Expires ~~ ' ~~!( '1/g Itf I I 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 tirneline 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. I 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 ~t7~_ 6~rf . Date {II /:t-L{/II / h/zy/ II pre - For Office Use Job# Sf(-Ol 5"7 0 Receipt# 2ol( - - /76] Z02 - Amount Collected Shared Drive(T:)lBuilding FormsIBlimp]ennants_Balloons 7-08.doc J ~. . www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2011-01570 1162 GATEWAY LOOP CITY OF SPRINGFIELD 225 Fifth 8t Springfield,OR 97477 541-726-3753 permitcenter@ci.springfield.or.us tL~~YJ~gtl:r.A1YJ'~:.l~P A.Y9J~'~'CASHIER:> DBOWLSBY" ~ ~~ Credit Card michael schwartz 05856p RECEIPT NO: 2011001763 RECORD NO: 811-SPR2011-01570 DATE: 06/24/2011 rDESCRll1.TION" ~ ' '~',. -e.:t.ttTI,';",":C'O;'p'i ',,-'TIn' 2' Ac:ceUNT!C0DE'!X'" Yo}'", -".,":.ti^MOUNT.DUE' ~ ~ I _ _ ,Admin.!.e."..I1 O'/~f appl~c~~e.!~)________ 224-000q~426605 1 8~00 224'00000-425602 80,00 821-00000-215500 100,00 100-00000-425605 4,00 ~._- --------- TOTAL DUE: 202,00 ~,-,C_QII'!Mg&:r,S' ,..,.~ "- ,_ -,;;;;-:,,;';AMOUNT;PAID~ - "':", ; , ;~ I refund to: sterling furniture 3194 202,00 gateway loop, springfield or 97477 _ BlimE.:..!l~a~~~ Sea_r.:~!~~____,,,___ ~ _-..~~~E:._B~.!!~o~, .~~~~~~~posit _~ Technolo~y fe~,(5% of permit total) TOTAL PAID: 202,00