SGN2012-00022 CITY OF TIGARD SIGN PERMIT
Permit #: SGN2012 -00022
COMMUNITY DEVELOPMENT Date Issued: 02/17/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 2S101AB00100
Jurisdiction: TIGARD
Name of Business: Meridian Acupuncture & Wellness
Business Address: 12005 SW 70TH AVE
Applicant/Agent: Meridian Acupuncture & Wellness,
Work Description: Placement of (1) one 24 s.f temporary banner. Valid 3/20/12- 4/20/12. Sign #2. Sign
must be on private property and not in the public right -of -way or visual clearance areas.
Permanent: No Freestanding: No Freeway: No
Temporary: 1 Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 4'x6'
Total Sign Area: 24
Wall Area:
Wall Face (Direction):
Sign Height: ft.
Projection From Wall: in.
Illumination: No Illumination
Materials: Banner
Electrical Permit Required: No
Building Permit Required: No
Total Permit Fee: $52.00
Conditions:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable law. All work will be done in accordance with approved plans. A permanent sign must be placed within
90 days from approval date or sign permit shall expire. A temporary sign shall expire 30 days from validity date. A balloon
sign shall expire 10 days from validity date.
,
Approved By:
Permittee Signature:
FEB -17 -2012 09:21 From: To:5035981960 P.2/3
REC E 'r
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City of Tigard FEB 17 2012
Sign Permit Application
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CF,NERAL INFORMATION
NPme off )evelotiment /Project
Site Re/A RocisC2enTEr lier.dico Aoiwtcuu.:4_
FOR ST FF USE ONLY
Address/ 5i iret Address CC. Permit No.: . 5 7I1 l Z. ....0002.M.
Location 17 5 5,i) 10 h. ANA Approved RY
%hie /1)Idg. # City/Stale Zip
llolwd o& c 72 23 Date : 3 f 2,1.1(2.-- /Z
N.u« VV Receipt #: fit; 7-7
Property `JRr1e p <e2 Map /'1'T.4: i LeS 1, /D x 001 —
Owner MailittY T
Addtrax quite Zoning: .__ u C
'I3519u 2.I "ii
'e3 and g d . Allowable Total A re,:
( hy /:Rate. Zip Phone a
li i)F( 9`12- SQ3 .. �i`i2- °16�U
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Tenant or ■ v e ljcclrical Permit Required? Li Ycs Pi to
Business /I4 p - td i ci„ A Cul)u.„e.Au: 4 ai l iel t L. Building l -crmii Required? ❑ Yes ElJVo
M Rev. 7/1/1I
A r � A �' 1 lL r \riupin \m sc.-Aland us applicaun is \tit n permit app dr
-SOU R `V ` W , �t 0
Sign
Contractor M rl sn "e / �f \
City /State Zip Phu= RFQUIREDSt IBM JTTALELEMENTS
Lake, 05,..), 5 /.3.63q - 53 55 (Note: appl;ca inns will not be accepted
p,
Ot on Const. t.linte License. !I Exp. Date without the rey aired submittal elements)
❑ Completed Application Form
Proposed P ❑ Permanent ❑ I'rree,•tPM1dmg ❑ f;,rcvuY Cj 2 copies of sire /pl(it plan, drawn to scale
Sta=n Tcutpori ❑ I(nnf 17 Electronic
(Chcck an that (3 copies, if a building permit is required)
WI) ❑ �'a4 ❑ Other
size requirement: S' /2" x 11 ", or l 1" x 17"
. ❑ 2 copies of cl(_-varions, drawn to scale
❑ New sign? ❑ A lter to existing sign?
(3 copies, if a built u1g permit is rcquirc(1)
Sign l)irtensions: size requirement: 4 x 11 ", to 24" x 36"
_s'c A Ci 0.10vt¢. o fervV A 61 USRxt
Total Si` t Area (sq. ft.): e. - i - ckic¢-i do 1. ».- ❑ $l65.00 Fee (Permanent sign, any size)
'rota] Wall Area (sq. ft.) ❑ $52.00 Fee (Temporary sign, an type)
Sign Data
(Complete all Direction Wall Laces (circle one):
it4'ma in this NOTES:
section) N S E W NE NW .S F. SW
Height to top of sign (feet): • Wall signs do no need to be drawn to scale, but
Projection From Wall (inches): must include dimensions of wall face and sign
Materials: p lacement.
• Wall signs do not require site /plot plans.
Will sign have illumination? ❑ Yes ,® No • Freestanding signs over 6 ft. required a building
Type; ❑ Internal ❑ External permit.
Art there any existing freestanding or wall signs at this location,
including wall signs That overlap a tenant space? _____I
❑ Yes ❑ No
If `ire ", a list or diagram of all sign dimensions and square (OVER FOR SIGNATURES)
FEB -17 -2012 09:21 From: To:5035981960 P.3'3
APPLICANTS:
To consider an application complete, you will need to submit ALL of the REQUI SUBMITTAL ELEMENTS as described on the
front of this application in the "Required Submittal Elements" box.
NOTE: Person specified as "Applicant" shall he designated "Permitter" and shall provide financial assurance for work
• When the owner and the applicant are different people, the applicant must he the purchaser of record or a lessee in possession with
written authorisation from the owner or an agent of the owner. The owncr(s) must sign this application in the space provided on the back
of this form or submit a written authorisation with this application
BY SIGNING BELOW, THE APPLICANT(S) SHALL CERTIFY THAT:
♦ 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, attachment's, and exhibit; transmitted .
herewith, are true, and the applicants so acknowledge that any permit issued, based on this application, and
may be revoked if it is found that any such statements are false.
o The applicant has read the entire contents of the application, including the policies and criteria, and
understands the requirements for approving and denying the application.
I hereby acknowledge that I have read this application, that the information given Li correct, that I am the
owner or authorized agent of the owner, and that plans submitted are in compliance with the City of Tigard.
SIGNATURES of each owner of the subject property are required.
1t I7 I
Applicant Signature Date
KSIs- 2 ' l l ' a`
Signature of Owner /Agent bate
` cin e C 603, 6 96 86
Contact Person Name. Phone No.
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Far 3 nly the work as described in:
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See Letter to: Follow
Attach
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7. ,, CITY OF TIGARD RECEIPT
.s .
13125 SW Hall Blvd., Tigard OR 97223
... e 3
503.639.4171
T.i
Receipt Number: 185577 - 02/17/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2012 -00022 Temporary Sign Permit 100 - 0000 -43115 $45.00
SGN2012 -00022 Temporary Sign Permit - LRP 100 - 0000 -43117 $7.00
Total: $52.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 34152B KPEERMAN 02/17/2012 $52.00
Payor: JANET. MCKEE
Total Payments: $52.00
Balance Due: $0.00
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