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SGN2003-00057 CITY OF TIGARD SIGN PERMIT �i, DEVELOPMENT SERVICES PERMIT #: SGN2003 -00057 �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/17/2003 PARCEL: 2S 102AC - 01704 BUSINESS NAME: TIGARD DENTAL ZONE: CBD SIGN LOCATION: 12720 SW PACIFIC HWY JURISDICTION: TIG APPLICANT /AGENT: BUSINESS TAX NO: SIGN PERMANENT: FREESTANDING: FREEWAY: TEMPORARY: X WALL: Y ELECTRONIC: OTHER: BILLBOARD: BALLOON: SIGN DIMENSIONS: 8'X2' TOTAL SIGN AREA: 16 sq. ft. • WALL AREA: sq. ft. WALL FACE (DIRECTION): SW SIGN HEIGHT: ft. PROJECTION FROM WALL: in. ILLUMINATION: NON DESCRIPTION OF SIGN: Placement of (1) one temporary banner. Valid 3/17/03 thru 4/16/03. Sign #3 MATERIALS: VINYL EXISTING SIGNS: 1 ELECTRICAL PERMIT REQUIRED: BUILDING PERMIT REQUIRED: ADMINISTRATIVE EXCEPTIONS: TOTAL PERMIT FEES: $ 15.00 • This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. A permanent sign must be placed within 90 days from approval • - . or sign permit shall expire. A temporary sign shall expire 30 days from validity date. A balloon sign shall expir — lays from validity date. r APPROVED BY: PERMITTEE SIGNATURE: x • DATE: 3/17/2003 ir w � �,��Iri, SIGN PERMIT APPLICATION CITY F I 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 I ( M E )f`Ft L lMu A &GS Address/ Street Address Permit No.: .56 3- t 00,57 Location 12720 s iPq- CSIFC FL( 42 Expiration Date: 3 - /'I -D3 ` -4-22 c l - AI. -v3 Suite /Bldg. # City /State Zip TI -ec 9 72Z, Receipt #: Name Approved By: Property kla V ie U i 6{-0 ADS Date: f 7 0 Owner Mailing Address Suite Map /TL #: 2-/ - - - 4C -Q / 70 >/ I2,7z© S L p14- e,iP/CF-{. 4-, Zoning: C 5D City /State Zip Phone T(G-iveAD OR C59 ?)55"2. "g2-71 Electrical Permit Required? ❑ Yes ❑ No • Tenant or Name Building Permit Required? ❑ Yes ❑ No Business Name Rev. 01- Jul -02 is \curpin \masters \revised \sign permit app.doc Sign C REQUIRED SUBMITTAL ELEMENTS Contractor Mailing Address Suite (Prior to permit (Note: applications will not be accepted issuance, a without the required submittal elements) copy of all City /State Zip Phone licenses are required if ❑ Completed Application Form expired in the Oregon Const. Cont. Board Exp. Date City of Tigard's License # ❑ 2 Copies of Site /Plot Plan, Drawn to Scale database) (3 copies, if a building permit is required) Proposed ❑ permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17" Sign ❑ Temporary ❑ Wall ❑ Electronic (Check all that ❑ Other ❑ Billboard ❑ Balloon 11) 2 copies of elevations, drawn to scale apply) (3 copies, if a building permit is required) ❑ New sign? a Alter to existing sign? size requirement: 81/2" x 11", to 24" x 36" • Sign Dimensions: gx 2 ❑ $30.00 Fee (Permanent sign, any size) Total Sign Area (sq. ft.): (f. ❑ $15.00 Fee (Temporary sign, any type) • Sign Data Total Wall Area (sq. ft.) (Complete all Direction Wall Faces (circle one): NOTES: items in this section) N S E W NE NW SE • Wall signs do not need to be drawn to scale, Height to top of sign (feet): but must include dimensions of wall face and Projection From Wall (inches): . sign placement. Copy: • Wall signs do not require site /plot plans. Materials: V I K Y L • Freestanding signs over 6 ft. required a building permit. Will sign have illumination? ❑ Yes ❑ No • If work authorized under a sign permit has not Type: ❑ Internal ign External been completed within ninety (90) days after Are there any existing freestanding or wall ss at this the issuance of the permit, THE PERMIT WILL location, including wall signs that overlap a tenant space? 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) • 14 11 ° 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.: 003 , 20 Sign ure of Owner /Agent Contact Person Name ne o. 1.1 l Y Ur I 1V r11vJ - ° - 13 12 5 SW Hall Blvd. 12:39:12PM Tigard, Oregon 97223 .,. -�] (503) 63 9-4 17 1 Receipt #: 27200300000000001013 Date: 03/17/2003 Line Items: Case No Tran Code Description Revenue Account No Amount Paid SGN2003 -00057 [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 CreditCard MARIA MIKTOR / TIGARD KJP 017620 In Person 15.00 DENTAL IMAGES Payment Total: $15.00 Page 1 of 1 cReceipt.rpt