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SGN2011-00065 i w RECEIVED • City of Tigar JUN 0 2 2 011 1, , CITY OF TIGARD Sign Permit Application PLANNMENGINEERING TIGARD GENERAL INFORMATION Name of Development /Project FOR STAFF USE ONLY Site TACO Be \ � ) ,;10 Address/ Street Address I I Permit No.: 'N (I ' COOL/ Location I I (v 3 S 5 w P0. G 1 ci G A Wy Approved By: Suite /Bldg. # City/State Zip R J� Ti vol, OR Date: (P 114 i 1 I Name Receipt #: Map /TL #: I S/300.6 m� Property O !l 1 o Owner Mailing Address Suite Zoning: W Allowable Total Area: 1 4'b S City/State Zip Phone Tenant or Name Electrical Permit Required? [e]'Yes El No Business — a,L 0 E e I 1 Building Permit Required? Yes ❑ No Name Rev. 7/1 /10 Sign Vr OI ` �� is \curpin \ masters \land use applications \sign permit app.doc Si .MLoLl. Contractor Mailing Address Suite Z600 NE Andresen Ra . City/State Zip Phone REQUIRED SUBMITTAL ELEMENTS Vaacou vtr 1.0A `1$(0(01 36o 613 1/773 (Note: applications will not be accepted Oregon Const. Cont. Board License # Exp. Date without the required submittal elements) `3 51 ❑ Completed Application Form Proposed P Permanent M Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale Sign Temporary Roof ❑ Electronic (Check all that (3 copies, if a building permit is required) apply) ❑ Wall °`h G boasa. size requirement: 8 x 11 ", or 11" x 17" ❑ 2 copies of elevations, drawn to scale New sign? IN Alter to existing sign? (3 copies, if a building permit is required) Sign Dimensions: , c5,, X , , 7 p size requirement: 8t /z" x 11 ", to 24" x 36" Total Sign Area (sq. ft.): � 4 3 O ° (D A ❑ $164.0 Fee (Permanent sign, any size) Si Data Total Wall Area (sq. ft.) El $52.00 Fee (Temporary sign, any type) /� (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): R! 5'' • Wall signs do not need to be drawn to scale, but Projection From Wall (inches): iv/A must include dimensions of wall face and sign placement. Materials: 5t6t1 , &Aryl , fat lL • Wall signs do not require site /plot plans. Will sign have illumination? JE Yes ❑ No • Freestanding signs over 6 ft. required a building Type: jst Internal ❑ External permit. Are there any existing freestanding or wall signs at this location, including wall signs that overlap a tenant space? El Yes ❑ No If "yes ", a list or diagram of all sign dimensions and square (OVER FOR SIGNATURES) footage must also be submitted. City of Tigard 1 13125 SW Hall Blvd., Tigard, OR 97223 1 503- 718 -2421 1 www.tigard - or.gov 1 Page 1 of 2 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. N � DATED this Z day of Ut.YI , 20 i .ignature of Owner /Agent A ' it Stor irn 3(90 - (53 - 1 1773 Contact Person Name Phone No. City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 I 503 -639 -4171 1 www.tigard - or.gov I Page 2 of 2 Existing Site Plan Draw the site plan layout. Use the space below or attach a separate page. Include the following with dimensional relationships: DT Window imim -Menu Board Location • Speaker Box -OCB Location (Distance from pick up window) Menu Board - Bollard Location -Light Pole Locations Clearance -Tree Locations * Bushes - Clearance Bar Location - Dumpster Location • Light Post All measurements should be in feet. Bollard 95' • 22.5" .._ ......_.- 1 \ • 20° O 108" 39.5" 73' -5" • CITY OF TIG ARD Approved -- • ' (t Conditionally Approved For only the work as desalt ed in: PERMIT NO. __ See Letter to: Attach Job A.. 2. Ei y: �q . Date / l/ k 7f0 D . , Z Confidential Document: Do not copy or distribute without written permission from Delphi Display Systems, Inc. Copyright ©2009. [Unpublished Work]. All rights reserved Community Development TIGARD Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: n Owner n Applicant n Contractor E City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City /State /Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): DQ CANCEL PERMIT APPLICATION. VO REFUND PERMIT FEES (attach receipt, if available). 6//07 INVOICE FOR FEES DUE (attach case fee schedule and explain below). REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: SGN2011 -00065 Site Address or Parcel #: 11635 SW Pacific Hwy 1S136DB00600 Project Name: Taco Bell Subdivision Name: Lot #: EXPLANATION: Permit determined to be exempt Signature: ��( (j'2 LJ Date: 6/2/2011 hirley Treat Print Name: Refund Policy L The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. • FOR.OFFICE USE ONLY Rte to S s Admin: Date B r Rte to ! ;i s Admire: Date - ��' B , gr g, Refund Processed: Date A/ B r ,t1i Invoice Processed: Date B Permit Canceled: Date ; :/(z/// By ('� • • eel Tag Added: Date By Receipt # Date / Method Amount $ I: \ Building \Forms \RegPennitAction.doc Rev 07/26/07