SGN2004-00206 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 1 day of 4-61 , 20 0 `1
9
Signature Own A gent
6 --- (5;5 - ) 6 2,0 —0'2-es
Contact Person Name Phone No. - - - --