SGN2002-00016 CITY OF TIGARD SIGN PERMIT
I i DEVELOPMENT SERVICES PERMIT #: SGN2002 -00016
e 2 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/24/02
EXPIRATION DATE:
BUSINESS NAME: SKIPPERS PARCEL: • 1S136CD - 0010
SIGN LOCATION: 11685 SW PACIFIC HWY
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: 832 sq. ft.
WALL FACE (DIRECTION): W
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 s xpire 30 days from approval date. A balloon sign shall expire 10
days frnm annrnval data
-—e-A-'91
APPROVED BY:
PERMITTEE SIGNATURE: I
DATE: 1/24/02
,.. 4
n„,,i�i, 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
Site S.. FOR STAFF USE ONLY
Address/ Street Addre 1 Permit No.: 36 zao 2 -000, 5d
Location j/ 0g6 Wt PA1',-GL �
Expiration Date:
Suite/Bldg. # Ci /State Zip
oQ 97a Receipt #: O - 00Z . V
me / Approved By:
Pro ert li e- t � �1 o b e Date: / 72 y/ - ''' .'(.1(. /
P y
Owner Mailing Address y 39 5, W, Suite Map/TL #: / S /3&c 0- O 0 / a 2.
5 4- CI A-■ L RVc� Zoning:
City /State Zip ao s Phone /�3)
0 2 ) Plo of q1 ass -6700
Tenant or ame l Electrical Permit Required? ❑Yes No
Business S k_j pp e..L-S Building Permit Required? ❑ Yes p No
Name {{�� (Ppk Rev. 30 -Jul-01 is \curpin \masters \revised \sign permit app.doc
Sign L- Lk I
Contractor Mailing Address • h Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit a'1 7 7 (p+ 4 Air (Note: applications will not be accepted
issuance, a
copy of all City /State Zip Phone (a S 3) without the required submittal elements)
licenses are
required if )< e - \
IJ'1 Lok (3'70-7617 ❑ Completed Application Form
expired in the Oregon Const. Cont. Boar Exp. Date
City of Tigard's License # ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
database) (3 copies, if a building ( p' g permit is required)
Proposed Permanent ❑ Freestanding size requirement: 8 x 11 ", or 11" x 17"
p g ❑ Freeway
Sign Temporary ❑ Wall ❑ Electronic ❑ 2 copies of elevations, drawn to scale
(Check all that ❑ Other ❑ Billboard 1:1 Balloon (3 copies, if a building permit is required)
apply) size requirement: 8 x 11 ", to 24" x 36"
igt New sign? ❑ Alter to existing sign?
❑ $50.00 Fee (Permanent sign, any size)
Sign Dimensions:
3X / Q ❑ $15.00 Fee (Temporary sign, any type)
Total Sign Area (sq. ft.):
30
NOTES:
Sign Data Total Wall Area (sq. ft.) q 3 Q ♦ Wall signs do not need to be drawn to scale,
o but must include dimensions of wall face and
(Complete all Direction Wall Faces (circle one): sign placement.
items in this ♦ Wall signs require plans.
section) N S E NE NW SE SW • Freestanding not over 6 site/plot
required a
Height to top of sign (feet): building permit.
Projection From Wall (inches): Y i 0 ♦ If work authorized under a sign permit has not
Copy: C (4.,\f been completed within ninety (90) days after
Materials: (Aly r - 40 0 ock the issuance of the permit, THE PERMIT WILL
Will sign have illumination? ❑ Yes No BECOME NULL AND VOID.
_ Type: ❑ Internal ftExter tial \
Are there any existing freestanding or wall signs at this 1 -Not all jurisdictions accept credit cards, please call jurisdiction for more information.
location, including wall signs that overlap a tenant space? visa ❑ MasterCard
A, ` Yes ❑ No Credit card number / /
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
'Signatu e of Owner /Agent
(04.0 - a 6 (02-
Contact Person Name
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Receipt #: 27200200000000000280
__._..� Date: 01124/2002
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