SGN2009-00092 c
CITY OF TIGARD SIGN PERMIT
: ' � ' . Permit #: SGN2009 -00092
COMMUNITY DEVELOPMENT Date Issued: 05/05/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S136CCO2100
Jurisdiction: Tigard
Name of Business: Dutch Bros. Coffee
Business Address: 11746 SW PACIFIC HWY
Applicant/Agent: Dutch Bros. Coffee,
Work Description: Placement of one (1) temporary sign 22" X 36" Sign #1 Valid 5/5/09 - 6/5/09 Must be
placed on private property, not in public right of way. Must meet visual clearance area
requirements
Permanent: No Freestanding: Freeway:
Temporary: 1 Wall: Electronic:
Billboard: Balloon:
Banner: A- Board: Yes
Sign Dimensions: 22" X 36"
Total Sign Area: 6
Wall Area: 6
Wall Face (Direction): East
Sign Height: 3 ft.
Projection From Wall: in.
Illumination: No Illumination
Materials: Plastic
Electrical Permit Required: No
Building Permit Required: No
Total Permit Fee: $19.00
Conditions:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all
other applicable law. 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.
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Approved By:
Permittee Signature: , a , ,
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. SIGN PERMIT APPLICATION
'r` m City of Tigard Permt Center 13125 SW Hall Blzd, Tiiarc>,'
Phone 503.639.4171 Fax: 503.598.1960 �,VED
MAY 0
5 2009
GENERAL INFORMATION Y
U ARP
P 4F TAG
Name of Development/Project t � G '`VEER r
"s t a FOR STAFF USE ONLY
Site A:
Address/ Street Address PermitNo.: SPlUo �R' 9 'O
Location 1 lP \L) p,z.f, 1-\-,..-i
Suite /Bldg. # City /State Zip Expiration Date:
k 411 u Receipt #: / 73 (e
N S Approved By: S. Ireicri
Property "(1 \ IArAtr/ rs Date: Slit) 7
Owner Mailing Address ' Suite Map/'n,# : t IS c Juc ' Dort
\t11L SI,J e (00ne -1 Cr Zoning:
9w/state Zip hon
Sv�� c� tit lyu03 ' 7
Tenant or Nam / Electrical Permit Required? ❑ Yes ❑ No
Business Building Permit Required? ❑ Yes ❑ No
Name Rev. 7 /1/07
i. \curpin \ masters \land use applications \ sign permit app.doc
Sign
Contractor Mailing Address Suite
(Pnor to permi
issuance, a
copy of all City/State Zip Phone REQUIRED SUBMITTAL ELEMENTS
licenses are (Note: applications will not be accepted
required if without the required submittal elements)
expired in the Oregon Const. Cont. Board License # Exp. Date
City of Tigard's
database) E ( Completed Application Form
Proposed ❑ rmanent ❑ Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
Sign y Temporary ❑ Wall ❑ Electronic (3 copies, if a building permit is required)
(Check all that ❑ Other ❑ Billboard ❑ Balloon size requirement: 8' /z" x 11", or 11" x 17"
apply) ze re q rement: r
['New sign? ❑ Aker to existing sign? ❑ 2 copies of elevations, drawn to scale
Sign Dimensio s: (3 copies, if a building permit is required)
7..1+n.h k`. -h..S size requirement: 8 " x 11 ", to 24" x 36"
Total 'pi Area (q. ft.
❑ $40.00 Fee (Permanent sign, any size)
Si Sign Data Total all Area (sq. ft.)
g [" $19.00 Fee (Temporary sign, any type)
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S ■f) NE NW SE SW
Height to top of sign (feet): 3.44,6 04 ,1 1 6 • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): must include dimensions of wall face and sign
placement.
spy . Wall signs do not require site /plot plans.
Materials: 65�1 • Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ Yes 1E'N permit.
Type: ❑ Internal ❑ External • If work authorized under a sign permit has not been
Are there any existing freestanding or wall signs at this location, completed within ninety (90) days after the issuance
including wall signs that overlap a tenant s ce? of the permit, THE PERMIT WILL BECOME
❑ Yes No NULL AND VOID.
If "yes ", a list or diagram of all sign dimensions and square
footage must also be submitted.
575 _ 44 (OVER FOR SIGNATURES)
r
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 5 day of 1 20 `Dc(
° if'" - 4
Signature of Owner /Agent
l u
6 ? ( 2 5
Contact Person Name Phone No.
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CITY OF TIGARD RECEIPT
,. 13125 SW Hall Blvd,, Tigard OR 97223
503.639.4171
TKGAAD
Receipt Number: 173416 - 05/05/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2009 -00092 Temp Sign Perm 100 - 0000 - 438050 $17.00
SGN2009 -00092 Temp Sign Perm - LRP 100 - 0000 - 438050 $2.00
Total: $19.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 005762 STREAT 05/05/2009 $19.00
Payor: Ryan Hawkins
Total Payments: $19.00
Balance Due: $0.00
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