HomeMy WebLinkAboutPermit Signage 2011-8-9
dtcn: J)Jlf/1 b
.':1~'~
.~;~-;t,~~e.~~.
225 FIITH STREET . SPRINGFIELD, OR 97477 . PH;(541)726-3753 . fAX; (541)726-3689
~; City Job Number S/ J -0 f '1 S I tJ/'ffE #=- t!tJ b / /- ~9 /
::~ Job Location 350/ /J{VNlP/('__ STI2a:::-I SPICU.JGF1l:::L./), ~
.,~ AssessorsMap-17 D Z- :SOl( ] Tax Lot 00/00 91Lf=f8
Oi&"':~:",M,eW!nE~tUMPJ!Wc.;
~ Owner of Property ~.F'Y /V1/'11..1~MGUI (!t).
.'E Address' )l/t7 13/)( b<.8::?1 Phon..(3b.1) ~ - 9319
GliJ, City I/I41J au t/az- State W 11- Zip q tl (p ~ 8
rtt!1
c.,ntract'orII mil{iller .
~, . Contr~ct~r
.,.~~
~:
~~
@."'.'
~,
~j
~,
~'
t))
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)andlor 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
<:U>) 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
lie' portable sign(s) has been removed,
J1 Si-rfr~-~r~n'" Kj1&IL
~, . ~ / For Office U\'e . ,'.
1s.; D f"A": (' ",' ';'/';/1 Job# 511-0r 9S1 'R" #Z-O{(~OZ.l~)
d' ate 0 pp lcatton / - ecelP':
~; Issued By -:v ~ Amount Collected 1/ S -
~y&j
~l ,I/)- / _/
~'No ~ ~~.L.#r ;
~~ A;~';.~~;~f--""-='-
';
...........
..~
~~
;,;;;;
,,;~,
I'!"t~'
~~'
~1
~)
."'~.i
l?~;
\W!!/~J
~1I"~'C\'llQl1"le:n.r.:. =;_-'1!
Gg' I\^I"~, / (J-'J
I ~ ....-. _.--'
~~~~
".. ~I
!'rilJI11~~t:lf:
:~flfJll{'i1.;
C>
N~~
Address
hooe
City
Zip
Construction Contractor.; License #
Expireo
Description 7-.
c~- 1';'''''LtY
Date of Installation
Date of Removal
.
Permit Fee: S225.00 inclllding SlOO.OO Deposit and applicable fees.
~
~/ .'
SP4~~~~L~
~~
~OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011..o1951
3501 OLYMPIC ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenter@ci,springfield.or.us
kBAY_I'!1E~I):YIiE~''t.. "P A YOR'", CASHIER' DBoWt,ssyr
Check cedartree mgt co
2425
RECEIPT NO: 2011002255 RECORD NO: 811-SPR2011-01951 DATE: 08/17/2011
!DESGRII!J'IONrq;" "it.,;,,', ". X~ 'f%';'\i,c")>;' .;:2.'.".....;\ .,.~gG.co.uN;fLG6oE..;' ,'.' ' . !"'AM6UN;f~D.oE;;"
Admin fee (10% of applicable fees) 224.00000-426605 10.00
Banner, Portable 224-00000-425602 100.00
Technology fee (5% of permittotal) 100-00000-425605 5.00
TOTAL DUE: 115.00
.,i.\'~" ,:,q~NfME~IS~2~Z7:~~;i~,~",~,'AMQUNT'leA,ID'p~:;~1~~~;~~;< )+'~~Li
115,00
,I
TOTAL PAID:
115.00