HOP2010-00031 HOME OCCUPATION PERMIT
� CITY OF TIGARD
',. 2 �.;, COMMUNITY DEVELOPMENT Permit #: HOP2010 -00031
:TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/04/2010
Parcel: 1 S 134DC00102
Jurisdiction: Tigard
Applicant Name: Bourque
Business Address: 11455 SW 115TH AVE
Nature of Business: Type I applicaton for internet retail /non -store retail business
Business Name: The Silver Rose Magick Shop Generate Extrn Noise: No
Sq Ft - Detached: Days /Hours of Operation:
Sq Ft - Residence: Bus. Vehicles Garaged @ Res: One
Sq Ft - Business: Outside Storage: No
SIC Code: Exterior Sign ?: No
Paid Non Res Empl: No
Cust/Client @ Res: No
Pick/Deliv @ Res: Yes
Acknowledgement:
I understand this Home Occupation Permit is approved for the above described business at the specified location only,
and does not require renewal. Further, I understand that the City of Tigard Business Tax must be renewed annually in
order to maintain permit authorization.
I acknowledge that this Home Occupation Permit approval may be revoked if the conditions and standards of approval
have not been complied with and /or this home occupation is otherwise being conducted in a manner contrary to the
Tigard Community Development Code (18.742). Permit revocation due to a violation of requirement(s) of this Home
Occupation Permit cannot be renewed for a minimum period of one year. (18.742.010).
dAtat /`---'"—<„
Approve By P rmittee Signature
IN HOME OCCUPATION
_ TYPE I APPLICATION� ?722'l �r EIVED
Cit of Tigard Permit Center 13125 SW Hall Blvd., Tigard, OR
1 1 (; A R D Phone: 503.639.4171 Fax: 503.598.1960 MAY 0 3 2010
CITY OF TIGARD
GENERAL INFORMATION PLANtjI /r.7 INEERING
Property Address /Location: / / T SS Sw S A-V
1 513 Dcoo /0 FOR STAFF USE ONLY
Tax Map & Tax Lot #: I Si 3y DC 00/00 Zone cL - i 5
E
Property Owner /Deed Holder(s) *: t c l 4,- n `mod v r-cj 5.. u .. - Case /Permit No.: 1 Gpa[ »0' �OD
Address: 1 ( 1 - I 55 Si)3 11nia tY' • Phone: - ( b "1 1 Filing Fee Rec'd.:$ � /
cc i-2-2. No.: / 7 7 (gY�
City: �t �O�CC\ �p vli 2'�� S . tI24 'tl
Application Approved By:
Applicant *: VC \ ivoY� iQ Date Approved: 57 Ili
Address: $ , 1 45 `J,St .c) 1151'V) I\Ve. Phone: 5o fir, 1,
3 TO t 113 I
Business Phone: SO?) 1-0 1 L) 13 1 Comp Plan /Zone Designation:
City: . te'+ c Zip: 'II 2 2 3
Business Name: —
: C S 1 Yer e f OS' ctc c LS hop Business Tax Paid? ❑ Yes ❑ No
f ' c� Business Tax Receipt No.
Nature of Business: L I'1 T F r qe �P AG 1
1400 - SA ore '....e___-\a', \ Rev. 7 /1/09
c \cutpin \ masters \land use applications \ home occupation permit -Type 1
app.doc
•
* When the owner and the applicant are different people, the applicant must be
the purchaser of record or a lessee in possession with written authorization
from the owner or an agent of the owner. The owner(s) must sign this _
application in the space provided on the back of this form or submit a written
authorization with this application.
REQUIRED SUBMITTAL ELEMENTS
THE APPLICANT SHALL CERTIFY THAT:
✓ The above request does not violate any deed restrictions that may be 1 Application Elements Submitted:
attached to or imposed upon the subject property.
✓ If the application is granted, the applicant will exercise the rights granted in ❑ Application Form
accordance with the terms and subject to all the conditions and limitations of
the approval. El Owner's Signature /Written Authorization
❑ Proof of Business Tax Certificate
✓ All of the above statements and the statements in the plot plan, attachments,
and exhibits transmitted herewith, are true; and the applicants so ❑ Filing Fee: $40.00
acknowledge that any permit issued, based on this application, may be
revoked if it is found that any such statements are false.
✓ The applicant has read the entire contents of the application, including the
policies and criteria, and understands the requirements for approving or
denying the application.
1
4 ` 94 - 1 T , ': , CITY OF TIGARD RECEIPT
, ✓' , 13125 SW Hall Blvd., Tigard OR 97223
.„it 503.639.4171
4TIGAItz
Receipt Number: 177786 - 05/04/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
HOP2010 -00031 Home Occupation Permit - Type 1 1003100 -43116 $35.00
HOP2010 -00031 Home Occupation Permit - Type 1 - LRP 1003100 -43117 $5.00
Total: $40.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 3628 STREAT 05/04/2010 $40.00
Payor: Gary Bourque
Total Payments: $40.00
Balance Due: $0.00
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a ' CITY OF TIGARD RECEIPT
I : . 13125 SW Hall Blvd., Tigard OR 97223
,,„;, 44 503.639.4171
1.T.IGARD
Receipt Number: 177789 - 05/04/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
06POS- 00000 40000 Business Tax 1003100 -43001 $79.50
Total: $79.50
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 3628 3628 STREAT 05/04/2010 $79.50
Payor: Gary Bourque
Total Payments: $79.50
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