SGN2005-00164 C ITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2005 -00164
-II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/6/2005
PARCEL: 2S 112DD -00300
BUSINESS NAME: SHELL FOOD MART & GAS ZONE: I -L
SIGN LOCATION: 15900 SW 72ND AVE JURISDICTION: TIG
APPLICANT /AGENT: SHELL FOOD MART
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3' X 4'
TOTAL SIGN AREA: 12 sq. ft.
WALL AREA: 690 sq. ft.
WALL FACE (DIRECTION): W
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: P
MATERIALS: VINYL /WOOD
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. A permanent sign must be placed within 90 days from
approval date or sign permit shall expire. A temporary sign shall expire 30 days from validity date. A balloon sign shall expire 10 days
from validity date.
APPROVED BY: �� O � '
PERMITTEE SIGNATURE:
DATE: 6/6/2005
.w t
' A�,il SIGN PERMIT APPLICATION
CITY OF TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name of Development/Project
Site D Pve l ( r b Wl 11'/1- (Y FOR STAFF USE ONLY
Address/ Street Address Permit No.: i G IQ, Q 0 5 00 i (j'f-
Location 15 00 SS&) (.f f !k/F3 I PA7 e ,
Expiration Date:
Suite /Bldg. # City /State Zip
(G rQ i � ` 1 7 3 Receipt #: 20 OS - a5 . .5'
Name � Approved By: C - et-t isuo
--� L.. to - 0 5"
Property 1 f YIiiQ C , L C(;4�r�
Date:
Owner Mailing Address .Suite , Map /TL #: ' S1 ( a_ DID - -v ::3 o
/S % SU ()P k eakil firi - 7 /zT, Zoning: /I l - 1,
City /State Zip Phone
T' ') de 97223 5117 6.2D - 1 Div
'Tenant or Name Electrical Permit Required? ❑ Yes in No
Business jk e (( F ki4 6 ttri t- `Ae ( r G,iS Building Permit Required? ❑ Yes w No
Name Rev. 1/3/05 is \curpin \masters \revised \sign permit app.doc
Sign -----
Contractor Mailing Address -Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit
.------ -------
-A o ,- -''
(Note: applications will not be accepted
issuance, a ,..�
copy of all City /Sta e Zip Phone without the required submittal elements)
licenses are �.
required if ❑ Completed Application Form
expired i��rr.th( Oregon Const. Cont. Board Exp. Date
Cit a re d s License # 111 2 Copies of Site /Plot Plan, Drawn to Scale
tab)
ase
(3 copies, if a building permit is required)
Proposed ❑ Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11", or 11" x 17"
Sign pff Temporary ❑ Wall ❑ Electronic
(Check all that ❑ Other ❑ Billboard 111 Balloon
111 2 copies of elevations, drawn to scale
apply) (3 copies, if a building permit is required)
❑ New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions•
< :, ❑ $37.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.):
p ❑ $17.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) `) Jurisdiction: ['City ❑ Urb
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S E W NE NW SE SW
Height to top of sign (feet): • Wall signs do not need to be drawn to scale,
Projection From Wall (inches): but must include dimensions of wall face and
sign placement.
Copy: • Wall signs do not require site /plot plans.
Materials: • Freestanding signs over 6 ft. required a
Will sign have illumination? ❑ Yes ❑ building permit.
No • If work authorized under a sign permit has not
Type: ❑ Internal ❑ External been completed within ninety (90) days after
Are there any existing freestanding or wall signs at this the issuance of the permit, THE PERMIT WILL
location, including wall signs that overlap a tenant space? BECOME NULL AND VOID.
❑ Yes ❑ No
If "yes ", a list or diagram of all sign dimensions and
square footage must also be submitted.
-
(OVER FOR SIGNATURES)
I hereby acknowledge that I have read this application, that the information given is
correct, that I am the owner or authorized agent of the owner, and that plans submitted are
in compliance with the City of Tigard.
DATED this day of , 20
/
N
Signature o caner /Agent
Contact Person Name Phone No.