SGN2002-00017 'a.
C ITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2002 -00017
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
DATE ISSUED: 1/24/02
EXPIRATION DATE:
BUSINESS NAME: SKIPPERS
SIGN LOCATION: 11685 SW PACIFIC HWY PARCEL: 1S136CD-0010
APPLICANT /AGENT: ZONE: C -
BUSINESS TAX NO: JURISDICTION: TIG
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3 X 10
TOTAL SIGN AREA: 30 sq. ft.
WALL AREA: 704 sq. ft.
WALL FACE (DIRECTION): NW
SIGN HEIGHT: ft.
PROJECTION FROM WALL: 1 in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Installation of (1) one permanent 3' x 10' wall sign. Banner must be enclosed with
a frame.
MATERIALS: VINYL /WOOD
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 50.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. A sign permit shall expire 90
days from approval date. A temporary sign all expire 30 days from approval date. A balloon sign shall expire 10
rlavc from annrnval riatP
APPROVED BY:
PERMITTEE SIGNATURE:'
DATE: 1/24/02
A!rf!.
AA 1 . il SIGN PERMIT APPLICATION
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 � � --ipP t S 5e7�2 - -U
Address/ Street Addre s Permit No.: (7
Location //t iY -51i PiAllie_. 14 t-O Expiration Date:
Suite /Bldg. # City/State ' Q Zip ( J y
Ti ad d t ( a ...3 Receipt #: --CVO ' "A -0
°
Name p 4�o ( f La b C? Approved By: 1 y'
Property
Date: � ; D-.- - ?, A ,,
Owner Mailing Address g 315'. (.J . Suite Map/TL #:, 1 6 C1- D O/ 0
S} LI A i t kve_ Zoning: C C
City /State Zip Phone (5a 3)
P it41 0 it ' 7 t: a.S um Electrical Permit Required? ❑ Yes la No
Tenant or Name
Business S IL pp et S Building Permit Required? ❑ Yes ❑ No
Name v v Rev. 30 -Jul -01 is \curpin \masters \revised \sign permit app.doc
Sign LAkAt e i 6- IAA h I e_S
Contractor Mailing Address • Suite R EQUIRED SUBMITTAL ELEMENTS
(Prior to permit �a-`t 17 Gf h A�� 5 (Note: applications will not be accepted
issuance, a
copy of all City /State Zip Phone 0 53) without the required submittal elements)
licenses are l ` /�
required if )(er�T, W 4 9 go3c,1 . 67 a - 710/7 ❑ Completed Application Form
expired in the Oregon CC nst. 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)
size requirement: 81/2" x 11 ", or 11" x 17"
Proposed /2 Permanent Freestanding I=1 Freeway
Sign ► �p..,_ Wall ❑ Electronic ❑ 2 copies of elevations, drawn to scale
(Check all that ❑ (3 copies, if a building permit is required)
apply) Other Billboard Balloon size requirement: 8 x 11 ", to 24" x 36"
j gj New sign? ❑ Alter to existing sign? ❑ $50.00 Fee (Permanent sign, any size)
Sign Dimensions: 3 X/
❑ $15.00 Fee (Temporary sign, any type)
Total Sign Area (sq. ft.):
,D NOTES:
Sign Data Total Wall Area (sq. ft.) /70 • Wall signs do not need to be drawn to scale,
but must include dimensions of wall face and
(Complete all Direction Wall Faces (circl- one). sign placement.
items in this
section) N S E W NE ® SE SW • Wall signs do not require site /plot plans.
• Freestanding signs over 6 ft. required a
Height to top of sign (fee : building permit.
Projection From Wall (inches): ■,, ;,), • If work authorized under a sign permit has not
Copy: pla// been completed within ninety (90) days after
Materials: - 41G/06, the issuance of the permit, THE PERMIT WILL
Will sign have illumination? • Yes j8 No BECOME NULL AND VOID.
Type: ❑ Internal n. xternal
Are there any existing freestanding or wall signs at this No all jurisdictions accept credit cards, please call jurisdiction for more information.
location, including wall signs that overlap a tenant space? visa ❑MasterCard
Credit card number / /
j4 Yes Expires
If "yes ", a list or diagram of all sign dimensions and Name of cardholder as shown on credit card
square footage must also be submitted. $
Cardholder signature Amount
(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 , 20
d f
Signature of Owner /Agent
Contact Person Name hone o.
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Receipt #: 27200200000000000280
_....�.,®, Date: 01/24/2002
T I D E M A R K
COMPUTER SYSTEMS, INC,
Line Items:
Case No Tran Code Description Revenue Account No. Amount Due
SGN2002 -00016 [SIGN] Sign Permit 100- 0000 - 437000 $50.00
SGN2002 -00017 [SIGN] Sign Permit 100 - 0000 - 437000 $50.00
Payments:
Method Payer Bank No Acct Check No Confirm No. Amount Paid
Check CHERYL A SASSE 0 1346 $100.00
TOTAL AMOUNT PAID: $100.00