SGN2020-00080 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 82-/ <00
■ Request for Permit Action
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner D Applicant ❑ Contractor ® City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANC /VOID PERMIT APPLICATION.
ND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: SGN2020-00080
Site Address or Parcel#: 2.20
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Project Name: GIOWAffleArS Cj GQ'
Subdivision Name: Lot#:
EXPLANATION: Duplicate of SGN2020-00077
Signature: f7 Gn Date: 12/22/2020
Print Name: Agnes in.j•r
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date.2 / Zq By ,'rV
Refund Processed: Date h//.st By 0 Invoice Processed: Date By
Permit Canceled: Date 3ii/y, By O Parcel Tag Added: Date By
I:\Building\Forms\RegPemutActio n_i't•i18.doc
111111
City of Tigard
. g CONIMUNITY DEVELOPMENT DEPARTMENT
i WARD Temporary Sign Permit Application /- zo
SITE INFORMATION
Address: ) I z o 5 t2 r4. �uK City/State:�'p � ��
/ � Zip: 22
Tenant/business name: TJ.p (etr Pt�Cr`5 iT o i^s.e _�
—y---S Zone: _
APPLICANT INFORMATION
Name: ..-- (Ie, C (r.-
Mailing address: )%2C4p �,0 f �- City/State: ✓ f; <
58 3 33 2 ?LI U �` j , zip: 97,`ta�{ ,
Phone: �e// Email: �cej�r, j hedmhJe"f oim s `.
•r ;
Applicant's representative: ,`�-,fl�nt,i (6- fger[h -49
Phone: 33,9 ?ticg Cell Ismail: sceb
5c.. , bbev'eui, T resA
PROPERTY OWNER INFORMATION ❑ Same as applicant „
Name: TiAr.t0 C &TP ,/ oxide,- 6c1 R-, rf"e LLC
Mailing address: /O9 Slrt) Iiev7rrace City/State: riyfl-al dr Zip: 9� '��
Phone: 5b3 .32 . 'V' Ce/( Email: of heY' t ver,, 0,M
SIGN INFORMATION
❑ Balloon Sign N- Banner Sign or ❑ Lawn Sign
Install date: (Valid for 10 days) Install date: I tA27/29° (Valid for 30 days)
!
Sign dimensions: Sign dimensions: X$
Sign area: Sign area: OZ s4 5f5, �t
I am the property owner or I am eligible to initiate this application,as provided inthe Tigard Community
Development Code. To the best of my knowledge,all the information provided within this application package is
complete and accurate.
7. "if;.04 C eve. "--
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Applicant's signature* Print name Date
_zii1e�s &G/ Zr 'P Z+v 61P6o he 0 C, igh-Tes /r/.2� oa u
Property owner's signature* Print name Date
. 'The property owner must sign this application or submit a separate written authorization when the owner and
-E` applicant are different people.
uimm
SGN2020-00080 $73 Received b : AL Date: 12/21/2020
Case No: Application fee: y
• Approved by:
AL Date: 12121l2020 Expiration date: 12/26/2020
City o/Tigard • 13125 S' Hall Blvd. • -Tigard,Oregon t97223 • wuuaigani-or.gov • 503-718-2421 • Page 1 off