SGN2004-00165 CITY TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2004 -00163
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/22/04 I6g
3
PARCEL: 1 S 1358 D -00900
BUSINESS NAME: BEAVERTON TIGARD INSURANCE ZONE: C -G
SIGN LOCATION: 09770 SW SHADY LN JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS:
TOTAL SIGN AREA: 24 sq. ft.
WALL AREA: 975 sq. ft.
WALL FACE (DIRECTION): N
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: new 11 S.F. sign, address sign is exempt
MATERIALS:
EXISTING SIGNS: 3
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED:
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 32.00
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 temporary sign shall expire 30 days from validity
date. A balloon sign shall expire 10 •:ys from validity date.
APPROVED BY:
PERMITTEE SIGNATURE:" ' "
DATE: 7/22/04
1
. .. , A
2_;14 SIGN PERMIT APPLICATION
CITY OF TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION SQ.)2oo9 001/5/(4 fl
Name of Development/Project
_ misso
Site 8/20.41-1-0A 110. � lASUL(XV'LC F OR STAFF USE ONLY
Address/ Street Address J Permit No.:
Location T170 S W S"% L4\
Expiration Date: //220
Suite /Bldg. #City /State Zip
1 436W -a 97 - �3 2
Receipt #: 004 2. - 3
Name v Approved By: 4
Property 5 1•_0_ Date: 7/7 VOL/
Owner Mailing Address Suite Map /TL #: 15/ 3S te9 00900
P 0 60y. zt j,9 Zoning: /14 VG
City /State Zip Phone
lilt 4
Ad 97I -31 Sv �
3'b-OZ�U Electrical Permit Required? ❑ Yes [ No
Tenant or Nam
Business
Building Permit Required? ❑ Yes [� No
Name Rev. 7/1/04 is \curpin \masters \revised \sign permit app.doc
Sign
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuance, a without the required submittal elements)
copy of all City /State Zip Phone
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 p' g permit is required)
Proposed x Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign ❑ Temporary El Wall El Electronic
(Check all that ❑ Other ❑ 2 copies of elevations, drawn to scale
❑ Billboard ❑ Ba lloon
apply) (3 copies, if a building ( p g permit is required)
K New sign? ❑ Alter to existing sign? size requirement: 81/2" x 11", to 24" x 36"
Sign Dimensions: RI $32.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): ❑ $1 5.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) 9 Jurisdiction: III City ❑ Urb
(Complete all Direction Wall Faces (circle one): NOTES:
items in this
section) 0 S E W NE NW SE SW
• Wall signs do not need to be drawn to scale,
Height to top of sign (feet): but must include dimensions of wall face and
Projection From Wall (inches): sign placement.
Copy: • Wall signs do not require site /plot plans.
Materials: • Freestanding signs over 6 ft. required a
Will sign have illumination? 2 Yes g No building permit.
Type: ❑ Internal External • If work authorized under a sign permit has not
Are there any existing freestanding or wall signs at this been completed within ninety (90) days after
location, including wall signs that overlap a tenant space? the issuance of the permit, THE PERMIT WILL
El Yes No BECOME NULL AND VOID.
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 A. JJ day of �,1 l,c , , 20
riAk)))-cV
Signature of Owner /Agent
Pte 5t3 -620 -023
Contact Person Name Phone No.
Ackitirkto ; t 7 S v.) S1? UN.
f Lpif.....) cap /rQ�ay.� : B- eagle- �r�9a
Dorr> Ivs'u.(al.�,�c ,. ..
. .
. . . .
C rv6 bf\J Q' SINf lx(o
•
J�
..: -----6.,,„..."-"."-°"'"'"". , 0 1
. \&`
) ' C Z
-- -- t tiV. = C f+
}
to' t .
. 3o' 1V)IkAQ\"1 ,
.—,
r 1 4
, - —
• s . . ' ' '
• I ; C t t L ( l ' , 1, ti. .(. i L 1- ,,, f4 'Zi - 0' C'L C.: t'-' -cetccostecct'ett0.-e
7 -4
I ( f
1
59-J-' .. .
V \\() N:a A ikkf •
•
4
I "
.....01
1 ....L., ,_..._____ ___
(__), ('7
c
N r....._ .......„.... X a
r■/\ \ -
\/ ________:_-____ v)
....-.
slY))1s ,z5m),(1, 1 5orr_)1
-neniii-fiVI
p/Ail-martYva-9 ; 41,Yvvvdi yrpkyo 3. i'tkr-) 1 g -V-H
.m Arms (y\ QLL b : moYIN1/4/
ot
opp � ; 1 h Z!, = h' Q 1 Lb1 zsa� ‘s � �y � ®Qs tea., aro O O
'11 N, L'A .,OZ 1 c'/ „Z.% x „S ►. 8I k „$ �
8 ' s 9 -1
s - L
-z% S 11 _k3 ))S „'Z1 O hhx „'I Q ,;�h�,,1� =�
,u 30 i , ti‘ i _ , ti . .
_ n
C)
o b a7( 1SN1 Q
4-.. yiv ,1- arvag CO
F ..; - -] :
/
- 2 7 N Q 1 0 , - I - 1
Ni Ms CLLb .va-'
CITY OF TIGARD 7/22/2004
13125 SW Hall Blvd. 1:10:08PM
, ,,.,u r (t, Tigard, Oregon 97223
67.11 (503) 639 -4171
Receipt #: 27200400000000003224
Date: 07/22/2004
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2004 -00163 [SIGN] Sign Permit 100 - 0000 - 437000 32.00
SGN2004 -00164 [SIGN] Sign Permit 100 - 0000 - 437000 32.00
SGN2004 -00165 [SIGN] Sign Permit 100 - 0000 - 437000 32.00
Line Item Total: $96.00
Payments:
Method Payer User ID Acct. /Check Approval No. How Received Amount Paid
CreditCard BEAVERTON INSURANCE MET 020095 In Person 96.00
Payment Total: $96.00
Page 1 of 1 cReceipt.rpt
•