SGN1997-00157 SIGN PERMIT APPLICATION
/n , i \ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
CITY OF TIGARD
GENERAL INFORMATION (PLEASE PRINT CLEARLY)
Sign Address /Location: /6 Sic tJ . ?tiL (
'Frei ��a 6) n/ Q })d y FOR STAFF USE ONLY
Name of Tenant/Business: t`7 A ti 11 0e S r vtt' E�
b , Date:Received -- -- - t.': . . .
Address: 0 - t i a_ S a. � t.
j S- / ?Received fJ .'.:-1:.::•:. .
1, - 1 , 4/41- � J :;P.ermit Na s Sin Com an : 1' - i'r cl� - 6 , 6Qr o m E.) `::. / Applicant/Agent/Contact Person: Of0-t t - f. 7
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Sign P Y Phone: �}o ;;;.;:; s :;;: >: Q
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Address: .? Sc-1 , ' 7) tt AC . ''
City: �( n.>'� State�4 Zip: /�d Receipt No: : ,�� nn
P , . Ci3O
Approved B ..
Sig n Company � C ( `L ( ! D at e : of A .. 11 „ : .1":: „ -
Co pany C.C.B. #:
Expiration Date: / • 3 0 , 94 Expiration; Date :: c9? :F: /: 3. : :;Y:q. :
City of Tigard Business Tax #:
(or) Expiration Date:
Metro Business License #: O ccc) i C99
/ Expiration Date: l l 9 e
Electri permit Required? :Yes` `:• . No O
Proposed Sign: (check as many as applicable) ::B uilding ; : : P ermit: Requi ?. Y ❑.'.; No
Permanent P. Freestanding ❑ Freeway ❑ Rev. , 12/27/96: Llcurpin■masters\spa.doc
Temporary ❑ Wall 0 Electronic ❑ nn ' /
Other ❑ Billboard ❑ Balloon ❑ Imo', bu P'9 7” 041s-2 1 le
Sign Dimensions : - Z. ' . ` 7� D: - .
Total Sign Areas (sq. ft.) 7 r t i4 i'� 0 REQUIRED SUBMITTAL ELEMENTS
Total Wall Area (sq. ft.): Co
Direction Wall Faces: (circle one) N S E 91 NE NW SE SW ❑ Completed Application Form
Height (ft.): / ig ' ❑ Site /Plot Plan Drawn to Scale
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Projection from Wall: (2 copies, 3 if a building permit is required)
❑ Elevations Drawn to Scale
Illumination: Yes va No ❑ Type: Internal VI External ❑ (2 copies, 3 if a building permit is required)
U.L. Label #: ❑ Applicant's Statement
Copy: R lei (ti 1-q 1/11 e4g4 ,e,vt it Fee (Permanent Sign, any size) $50.00
Materials: ll i 0( 0(.4 c (; C , a lr t>2�il wo
0 Fee (Temporary Sign) $15.00
Are there any Existing Signs at this Location? Yes it No' ❑ I certify that I am the recorded owner of the
Of yes, a list of all sign dimensions must also be submlttedJ property or a agent authorized by the owner.
NOTE: c> If work authorized under a sign permit has not been / 1A-4 .
completed within ninety days after the issuance of the
permit THE PERMIT SHALL BECOME NULL AND VOID. Applicant's Signature
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1 io _j, y�
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List any VARIANCE OR OTHER LAND USE ACTIONS to be considered as part of this application:
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APPLICANTS:
To consider an application complete, you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as
described on the front of this application in the "Required Submittal Elements" box.
(Detailed Submittal Requirement Information sheets can be obtained, upon request, for all types of Land Use Applications.)
THE APPLICANT(S) SHALL CERTIFY THAT:
• The above request does not violate any deed restrictions that may be attached to or imposed upon the subject
property,,
• If the application is granted, the applicant will exercise the rights granted in accordance with the terms and subject to all
the conditions and limitations of the approval.
• All of the above statements and the statements in the plot plan, attachments, and exhibits transmitted herewith, are true;
and the applicants so 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.
SIGNATURES of each owner of the subject property.
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DATED this day of , 19
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Owner's Signature Owner's Signature
Owner's Signature . Owner's Signature
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