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SGN2003-00240 Core Brz)(,)nI.e_e_ toa —sv-7S kaz. (` `i - 0 �''' —'"�'� // v 0 0 ...e_ ( f , - 1.L. /(4.„,( 3 . s k1�co ,,,.,,,,1,„ SIGN PERMIT APPLIC TION . ~ I �! e � CITY OF TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297 GENERAL INFORMATION Name of Development/Project FOR STAFF USE ONLY Site Address/ Street Address Permit No.: 5 G 2,30 3— 0 ©Z V rj Location /305 SW O kc g Expiration Date: Suite /Bldg. # City /State Zip TO - a.ret— 9 7d2.23 Receipt #: P —`l 3 `t t• - -2 -605 4597 -4.4.....1 Name Approved By: /-- Property Dk Si U C it S C Date: / / (I Owner Mailing Address 4t- I 0 1 Suite Map/TL #: 41-30 66t) Mae 04. l 0, . - Zoning: ( G " City/State Zip Phone Tor-I'( a'^ 677 c Electrical Permit Required? ❑ Yes [—No Tenant or Name Business ..---- k_ — 50E se Building Permit Required? ❑ Yes E—No Name Rev. 2/28/2003 is \curpin \masters\revised \sign permit app.doc Sign Contractor Mailing Address suite REQUIRED SUBMITTAL ELEMENTS (Prior to permit applications will not be accepted issuance, a copy of all City /State Zip Phone without the required submittal elements) licenses are • required if ❑ Completed Application Form expired in theme - Oregon Const. Cont. Board Exp. Date City of Tigard's License # ❑ 2 Copies of Site /Plot Plan, Drawn to Scale database) z (3 copies, if a building permit is required) Proposed ❑ P manent ❑ Freestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17" Sign Temporary ❑ Wall ❑ Electronic (Check all that Other ❑ Billboard ❑ Balloon ❑ 2 copies of elevations, drawn to scale apply) (3 copies, if a building permit is required) ❑ New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36" Sign Dimensions: 3 x ❑ $36700 Fee (Permanent sign, any size) Total Sign Area (sq. ft.): 1 / , 00 /<.a._ El $15.00 Fee (Temporary sign, any type) Sign Data Total Wall Area (sq. ft.) Jurisdiction: ❑ City ID Urb (Complete all Direction Wall. Faces (circle one): NOTES: items in this section) N S E W NE NW SE SW • Height to top of sign (feet): • Wall signs do not need to be drawn to scale, Projection From Wall (inches): but must include dimensions of wall face and sign placement. Copy: tj v u o • Wall signs do not require site /plot plans. Materials: • Freestanding signs over 6 ft. required a Will sign have illumination? ❑ Yes ❑ 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 BECOME NULL AND VOID. ❑ Yes ❑ No 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 day of 3 , 20 O � Signature of Owner /Agent 0 re- roan/ - (v) 6,940 So T� Contact Person Name Phone o. . . __,_ • izo_,„4„ 5— (0% cf — Ltk _....... _. ............ _ __........... --. • _—• • ........• .... .....• _ _____. _ ...._. -- p o _c_,....• e. 4...7. ......_.. - ______.. S i de_•,)zate- 45 --- . 1 i Cke1/4S5 ■,..s \e, ,I _______________--- 1 • \ 1 \ .. A. ----.0 c• r b.s, \bc). .p. C-CaPscc\ e_. 3 _....... le- 2:10 . v ( . _ -1 ' 5rntioi ikiSS . 3.‘S 4Nzs. A3;_ S it 3 t ea. nockisks i;*1 INI■Nt...\2_51-W•kka 11^NoCAA k 6 c32. 2.2o Mt LAkstk mks" - 3.SC i.0 Ct. 1.5N--c-res a . SS L.Prri . i 5 ca,m eS khc'eSTIXAS SARtIkM(IkkV4 ,, CL 1 1 CeAt 1 I 17 c kl k Cc" I GzScr". ( 1 M i i C r.. i I 1 i 0 1 : i_lkIkCE\ i 1 1 ...---- ) ------- Q.--, ( --- i ... T Y OF .7 1 SiA .4;4 im A - 1 ---- ______________..___ _._ cI, ,. ,y Approved . . - ..11y the vvort as ;.:escri!zetil ol: f :-ciMIT NO._$ -000(0 _.. : l_e!:.:r te• Follow... ... 1 I n_ I p r\e\ .,__.. • ;:at..... _ ; 1 .....) J1 =■ ld••: 3 (Lc i-ft.)1 6jc) L. v _ -.! 77:— _._ . CITY OF TIGARD 10/10/2003 13125 SW Hall Blvd. 3:43:07PM Tigard, Oregon 97223 °T) ! (503) 63 9-4 17 1 Refund Receipt #: 27200300000000004397 Date: 10/03/2003 Line Items: Case No Tran Code Description Revenue Account No Amount Paid SGN2003 -00240 Refund - [SIGN] Temp Sign Perm 100 - 0000 - 437000 (15.00) Line Item Total: ($15.00) Refund: Method Payer User ID Acct. /Check Approval No. How Received Amount Paid Cash Refund JAVA JUICE DLH In Person (15.00) Refund Total: ($15.00) Page 1 of 1 cReceipt.rpt LA I Y UN 11liAKU tuiiizuw 13125 SW Hall Blvd. 2:04:49PM Aid it i ,1� Tigard, Oregon 97223 LL (503) 63 9-4 17 1 Receipt #: 27200300000000004396 Date: 10 /03/2003 Line Items: Case No Tran Code Description Revenue Account No Amount Paid SGN2003 -00240 [SIGN] Temp Sign Perm 100- 0000 - 437000 15.00 Line Item Total: $15.00 Payments: Method Payer User ID Acct. /Check Approval No. How Received Amount Paid Cash JAVA JUICE KJP In Person 15.00 Payment Total: $15.00 Page 1 of 1 cReceipt.rpt •