SGN2005-00304 CITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2005 -00304
^` ' '— 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/17/2005
PARCEL: 1S136DB
BUSINESS NAME: FRED MEYERS ZONE: C -
SIGN LOCATION: 11565 SW PACIFIC HWY JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 2.5' X 6'
TOTAL SIGN AREA: 17 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION): SE
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Installaton of (1) one 17 sq. ft. permanent wall sign.
Vinyl banner must be framed.
MATERIALS: VINLY /FRAME
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 38.00
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 to •orary sign shall expire 30 days from validity date. A balloon sign shall expire 10 days
from validity date.
APPROVED BY: ",1 f
PERMITTEE SIGNATURE: -� - , '
DATE: 10/105
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- 1'i1►I SIGN PERMIT APPLICATION
CITY OF TIGARD 13125 SW Ha11 Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
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GENERAL INFORMATION
Name of Development/Project
FOR STAFF USE ONLY
Site Pr t to 1ev j
Address/ Street Address Permit No.: 5 ( - " S''- ' 0 0 30 '7 4
Location i 15(,c 3(,t) P 4- C T7wy Expiration Date:
Suite /Bldg. # City /State Zip
7>,rice4 9 7 ,2 �S Receipt #:
Name Approved By: /&--'
Property Fice4 ,-(. .eiz/
Date: 1b 1/ 1(°�
Owner Mailing Address / Suite Map/TL #:
Zoning: C
City /State Zip Phone
Tenant or Name
Electrical Permit Required? ❑ Yes E -No
Business ,--- Building Permit Required? ❑ Yes [ to
Name Rev. 7/1/05 is \curpin \masters \revised \siqn permit app.doc
Sign
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuance, a
copy of all City /State Zip Phone w ithout the required submittal elements)
licenses are
required if ❑ Completed Application Form
expired in the Oregon Const. Cont. Board Exp. Date
City of Tigard's License # ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
database)
(3 copies, if a building permit is required)
Proposed Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign ❑ Temporary ❑ W ❑ Electronic
(Check all that ❑ Other ❑ Billboard ❑ Balloon ❑ 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: 7 X C
❑ $38.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.):
(? 5i . ,�' ---(- ❑ $18.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) Jurisdiction: El City El 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
sign have illumination? ❑ Yes ❑ building permit.
o • If work authorized under a sign permit has not
ype: ❑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)
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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
Vii:,
Signat-. of Owner /Agent
Jov.e,*ri 53
Contact Person Name Phone No.
(O.
2:72-
A CITY OF TIGARD 10/17/2005
13125 SW Hall Blvd. 1:26:56PM
4 . , Tigard, Oregon 97223
' � � (50 3) 63 9-417 1
Receipt #: 27200500000000005246
Date: 10/17/2005
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2005 -00304 [SIGN] Sign Permit 100 - 0000 - 437000 33.00
SGN2005 -00304 [LRPF] LR Planning Surcharge 100 - 0000 - 438050 5.00
Line Item Total: $38.00
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Cash FRED MEYERS KJP In Person 38.00
Payment Total: $38.00
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