SGN1993-00008 •
SIGN PERMIT
PERMIT #: SGN93 -0008 DATE ISSUED • 07/08/93
EXPIRATION DATE: 10/07/93
PARCEL • 1S136AD -06000
ZONE • C -G
BUSINESS NAME..: KENTUCKY FRIED CHICKEN
SIGN LOCATION..: 11433 SW PACIFIC HWY
APPLICANT /AGENT: ACKERLEY COMMUNICATIONS, INC.
BUSINESS TAX NO:
SIGN:
PERMANENT (X) FREESTANDING (X) FREEWAY ( )
TEMPORARY ( ) WALL ( ) ELECTRONIC ( )
OTHER ( ) BILLBOARD (X) BALLOON ( )
SIGN DIMENSIONS • 14'X 48'X 2
TOTAL SIGN AREA • 1344 sq.ft.
WALL AREA • sq.ft.
WALL FACE (DIRECTION): NA
SIGN HEIGHT • 40 ft.
PROJECTION FROM WALL.: in.
ILLUMINATION • INT
DESCRIPTION OF SIGN:
PERMANENT FREESTANDING BILLBOARD SIGN. 14' X 48' X 2 = 1344 SQ.FT
MATERIALS • STEEL /WOOD
EXISTING SIGNS • 0
ELECTRICAL PERMIT REQUIRED: YES
BUILDING PERMIT REQUIRED..: YES
ADMINISTRATIVE EXCEPTIONS.: N/A
PERMIT FEE: $ 35.00
APPROVED BY:
DATE: 07/08/93
RECEIVED
JUL 0 71993
COMMUNITY DEVELOPMENT
ACKERLEY COMMUNICATIONS
OF THE NORTHWEST, INC.
July 6, 1993
Victor Adonri
City Planner
City Tigard
13125 SW Hall Blvd
Tigard, OR 97223
RE: Permit #SGN93 -0008
Dear Victor,
Due to circumstances beyond the control of Ackerley Communications, it is necessary
that I request an extension for this permit.
Your cooperation and understanding in regards to this matter is greatly appreciated.
Best Regards,
Mary . erkel
Real EState Representative
715 N.E. Everett, Portland, OR 97232 / Phone: (503) 232 -3111 / FAX (503) 232 -7937
SIGN PERMIT
PERMIT #: SGN93 -0008 DATE ISSUED • 04/07/93
EXPIRATION DATE: C6/07/5t3
PARCEL • 1S136AD -06000
ZONE • C -G
BUSINESS NAME..: KENTUCKY FRIED CHICKEN
SIGN LOCATION..: 11433 SW PACIFIC HWY
APPLICANT /AGENT: ACKERLEY COMMUNICATIONS, INC.
BUSINESS TAX NO:
SIGN:
PERMANENT (X) FREESTANDING (X) FREEWAY ( )
TEMPORARY ( ) WALL ( ) ELECTRONIC { )
OTHER ( ) BILLBOARD (X) BALLOON ( )
SIGN DIMENSIONS • 14'X 48'X 2
TOTAL SIGN AREA • 1344 sq.ft.
WALL AREA • sq.ft.
WALL FACE (DIRECTION): NA
SIGN HEIGHT • 40 ft.
PROJECTION FROM WALL.: in.
ILLUMINATION • INT
DESCRIPTION OF SIGN:
PERMANENT FREESTANDING BILLBOARD SIGN. 14' X 48' X 2 = 1344 SQ.FT
MATERIALS • STEEL /WOOD
EXISTING SIGNS • 0
ELECTRICAL PERMIT REQUIRED: YES
BUILDING PERMIT REQUIRED..: YES
ADMINISTRATIVE EXCEPTIONS.: N/A
PERMIT FEE: $ 35.00
•
APPROVED BY:
(
DATE: 04/07/93
Permit .No_ -SG N q —)
CITY OF TIGARD
SIGN PERMIT APPLICATION
•
The applicant hereby applies for a permit for the work indicated or as shown in the
accompanying plans and specifications_
SIGN LOCATION ADDRESS: I I LA 33 'ac i �; c ZONING: • (ovorv\
NAME OF BUSINESS: �-Q^^� Y P C L• i c ep
A P P L I C A N T / A G E N T : (' C ANY: Ar .e P l ey PHONE: 2 -3 f)
The City of - Tigard imposes an annual Business Tax which must be kept Cult on all
persons doing business in the . City_ Do you presently have a current. business tax?
YES ) NO C ) ILL- Label - I-
-
PROPOSED SIGN: (Check as many as apply)
PERMANENT (,- C) FREESTANDING 0 FREEWAY ( )
TEMPWARY ( ) SAIL ( ) ELECTRONIC ( •)
OIL ( ) . BILLBOARD K) BAI JJON ( )
SIGN DIMENSIONS: I �{ . x • X 2 DOPIRATION DATE:
TOTAL SIGN AREA (Sq_ Ft.): // (0 7 � k 7 = /_ °� T 1' .
WALL AREA (Sq. Ft.):
WiAIX, FACE : -
HUGH:I (Ft): a
P R O J E C T I O N E1 (SiZei L: -
IL TION: YES ()c) . NO ( ) TYPE:
OOPY: 3; \ \boot" {
MATERIALS: ��e-` l v-) •c
SI0 � C
F.�QST.IIdG G*LS: Q v�
ACKIXESTRATIVE EXCEPTION: N/A. ( APP ED ( ) IICW war .
mot. ( ) HEIGHT ( )
Ca9M4ENLS: •
PLANNING DEPARTMENT • All sign permits mast be accompanied by a scale
Permit Fee: 3S ± = 77,2) drawing and plot plan_ If work authorized ur der
Receipt No: 9 S -2gha a sign permit has not been completed within ninety
Approved BY: +I days after the issuance of the permit, the permit
Date: -- } 7 -- 93 shall become null and void. •
ELECTRICAL I12ICAL PFE2MCT�� I enrol ,,'7 TI AT I AM TME REXDRDED OWNER OF THE
ED
REQUIR: YES (1 J No ( )
OR ''! ' o•� ' r ZED BY THE OWNER_
BUIIDING PEZ-Hr • `
RD:MIRED_ YES ( ( ) App '"cant`s Signature
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SIGN PERMIT APPLIGA t IUN
° Tied Or•`°" oat of OFF PREMISE OUTDOOR ADVERTISING SIGN
7
HIGHWAY DIVISION OREG STATE HIGHWAY DIVISION, SIGN PERMIT UNIT, HIGHWAY OPERATIONS BUILDING
2950 STATE STREET E., ROOM 209, SALEM OR 97310
PERMIT OFFICE APPROVAL SECTION
,: APPROVED BY PERMIT RINSER ISSUE DATE
SECTION 1 - PURPOSE OF APPLICATION > 0 :
'F`
CONSTRUCTION DATE
O RECONSTRUCTION OF PERMIT NO F O CONFORMING
RELOCATION iN LIEU OF PERMIT NOTE' ✓ + C p NONCONFORMING
E REASON
❑ BUSINESS IDENTIFICATION' CI BENCH
?::UZz: OWNE CODE 'HIGHWAY CODE DISTRICT
O DIRECTIONAL** 0 BUS >S<
SHELTER ? [E CANCELLATION DATE WAS TAG RETUFNED .
O YES ONO
SECTION 2 - NAMES AND ADDRESSES
N E OF SIGN OWNER SITE FIELD CHECK
Y' Ackerley Communications (TO BE COMPLETED BY DISTRICT MAINT. OFFICE )
NUMBER AND STREET • i •' • • e "• It - el e• • • • • ' • • • •
(03 200 97 /2/23/9.
715 NE Everett ' ?<
CITY, STATE AND ZIP CODE OW R OF NEAREST EXISTWG OFF•PREMISE SIGN ON SAME SIDE OF HIGHWAY
Portland, OR 7232 °' ' I 3:14 C
T . - , . • • : - • i• • • DIRECTION TO PROPOSED SIGN
NAME OF PROPERTY OWNERATSIGN LOCATION ::.:
(2.39 M;( Aloe- k
KFC of California 'U' 75 0 1 6 o , ' , . •- EFIVISOR'S SIGNATURE)
NUMBER AND STREET ` S. >
11435 SW Pacific Highway .E ' '` 2
CITY, Si ATE AND ZIP CODE
Tigard, OR 97223 SECTION 4 - SIGN FACTS
( A) SIGN DIMENSIONS - EXCLUDE SUPPORTS
NAME OF PERSON OR COMPANYTO ERECT SIGN HEIGHT ( FEET) LENGTH ( FEET) AREA (SO. FT.)
Ackerley Communications
NUMBER AND STREEr VI4R42KRITTaralWrii5117 I A C: EN AND G N
715 NE Everett 1 - 30" steel pipe 40'
CITY, STATE AND ZIP CODE PROPOSED DATE TO INSTALL ADVERTISING IS ON
Portland, OR 97232 2/1/93 O ONE SIDE 53x BOTH SIDES
SECTION 3 - SKETCH OF SIGN ( B) SIGN LOCATION
SKETCH OF SIGN INCLUDING MESSAGE COUNTY CITY (OR DISTANCE FROM )
( 4 Y., , Washington Tigard
HIGHWAY ROUTE NUMBER OR NAME
1 / -Hwy 99W
C .! /J � SIDE OF HIGHWAY
wL )4 O NORTH O SOUTH 0 EAST 53 WEST
7 t/(- ^ 'iJ D L�61/Z---- I (C) *COMPLETE THIS BOX FOR BUSINESS IDENTIFICATION SIGNS
(� ' ----r , 1 - DISTANCE FROM PROPOSED SIGN TO BUSINESS ACTIVITY
2 - IS BUSINESS ACTIVITY OR ANY OF ITS ADVERTISING VISIBLE FROM HIGHWAY?
CI YES : 0 - - - R ADVERTISING '!
(D) I -- COMPLETW DIRECTIONAL • IGNS
I
t - SIZE OF CPY LETTERS CC
2 - COLOR OF r ACKBOARD AND LETTERS
SIGN MUST NOT IMITATE OR RESEMBLE, IN STYLE OR 11 g AS............OS
3 - SUBMIT WIT } T-6-Te HOW THAT
COLOR, STATE HIGHWAY OFFICIAL SIGNS OR DEVICES THE BUSINE I oN gruel- Fw!MPLTESt BROCHURES,
FOR OFFFICE USE ONLY B -PAGES FROMW91Tfi1fRSt'OGrC=FACTT OR SAMPLES OF
OUT OFSTATE ADVERTISING PROGRAM
' - RMIT FEE( SEE INSTRUCTIONS FOR RATE) /J
734 -3451 (2 -90 )
ZONE AFFIDAVIT
INSTRUCTIONS: After completing Sections A,B, and C, contact the appropriate city or county zoning authority for
verification of the zoning and completion of the sign compliance section.
NAME OF SIGN OWNER
Ackerley Communications
NUMBER AND STREET
A 715 NE Everett
CITY, STATE AND ZIP CODE
Portland, OR 97232
NAME OF PROPERTY OWNER
Kentucky Fried Chicken of California Inc.
NUMBER AND STREt r
B 3100 Lake Center Drive Suite 200
CRY. STATE AND ZIP, CODE
Santa Ana, Ca 92704 -6943
SIGN LOCATION
( REFER TO OTHER SIDE OF THIS APPLICATION
CITY (IF INSIDE CITY) COUNTY HIGHWAY ROUTE NUMBER OR NAME SIDE OF HIGHWAY MILE POINT
C g
Tia rd Washington Hwy 99W West TAX LOT SECTION TOWNSHIP RANGE
6000 1s 1W 36 AD
TO BE COMPLETED BY CITY OR COUNTY ZONING AUTHORITY
ABOVE LOCATION IS ZONED DATE ZONING WASFEFfECTNE ZONING AUTHORITY ( NAME OF CITY OR COUNTY
'COMMERCIAL O INDUSTRIAL _
ct OTHER �rsa Uarrx t w retal t � �3 C°• ;7 dT r �< <t c,l^ci
SPECIFY LJ
CHECK APPLICABLE STATEMENT
This will certify that the above described sign location is zoned as indicated above and said zoning was established
as part of a comprehensive plan for the development of the overall area and not as spot or strip zoning devised
primarily for the purpose of allowing outdoor advertising signs. Erroneous information and /or improper zoning
procedures will result in permit being declared null and void, requiring removal of subject sign or signs.
IT IS FURTHER CERTIFIED THAT THE SIGN PROPOSED BY THIS APPLICATION COMPLIES WITH ALL
APPLICABLE ORDINANCES, PLANS, RULES AND OTHER REQUIREMENTS OF TI E.C OR COUNTY.
$ i3..1 Pe -w. t-r M P" y e A pe t r� d - r o r 4rer� - � -_ ( 4
0 Above location and / or proposed sign does not comply with local sign rules and regulations.
SIG ' • F . » "t • ' ZED ZONING REPRESENTATIVE
b ag - c7/
AGKEHLL'I COMMUNICATIONS
OF THE NOFITHWEST, INC.
Lease #
Date
1. The undersigned, as Lessor, hereby leases and grants
exclusively to ACKERLEY COMMUNICATIONS INC. as Lessee, the
property (with free access to and upon same) located in the City
of Tigard, County of Washington, State of Oregon, described as : a
Tax Lot 1SI 36 AD Lot 6000U"
Kentucky Fried Chicken 9r x Cif 11 „ /a)r1 C,, �r
11433 SW Pacific Highway
Tigard, OR 97223
as per map thereof recorded in the Office of the unt Recorder g�
o r in ton Count State of Oregon,
with the option to cancel provided V
r e purpose of erecting and maintaining advertising
signs thereon, including necessary supporting structures,
devices, illumination facilities and connections, service ladders
and other appurtenances thereon. ` See
2. A kerley Communications shall pa to KFC rental in the
amount of
3. Lessee shall save the Lessor harmless form all damage to
persons or property by reason of accidents resulting from the
negligent acts of its agents, employees or others employed in.the
construction, maintenance, repair'or removal of its signs on - "the - -
property. Lessee shall assume all liability for owning and
operating the sign and hold Lessor harmless for the period that
the sign remains. on the Lessor's property. Lessor will be named
as additional insured on Lessee's policy for said sign structure.
4. Lessor agrees that he, his tenants, agents, employees,
or any other persons acting in his behalf, shall not place or
maintain any object on the property which would in an wa
obstruct th- ' - *. ._ ion structure.
•
5. If the view of any of Lessee's signs is obstructed or
impaired in any way, or if the value of such signs is diminished
by reason of diversion or reduction of vehicular traffic, or if
the use of any such sign is prevented or restricted by law, or if
for any reason a building permit for erection or modification of
any such signs is refused, the Lessee may immediately at its
3601 6th Ave. S., Seattle, WA 98134 / Phone: (206) 682 -3833 / FAX (206) 447-0377
option adjust the rental in direct proportion to the decreased
value of the leased premises for advertising purposes, or may
terminate the lease and receive adjustment'for all rent paid for
the unexpired term.
6. This lease shall continue in full force and effect for
its term and thereafter for subsequent successive like terms
unless Lessor fails to renew the Master Lease with landowner or
unless terminated at the end of such term or any successive like
term upon written notice by the Lessor or Lessee served thirty
(30) days before the end of such term or subsequent like term.
Lessee shall have the right to terminate the Lease at the end of
any monthly period upon written notice to Lessor served not less
than thirty (30) days prior to the end of such monthly period.
Lessor shall have the right to terminate the Lease at any time
during the period of this lease if the Lessor is to improve the
unimproved property by erecting thereon a permanent private
commercial or residential building. Lessee shall remove its
signs within thirty (30) days after receipt of a copy of the
*applicable building permit. The Lessor will upon giving such
notice of building, return to the Lessee all rent paid for the
unexpired term plus the total cost of the construction and the
removal of Lessee's signs, less 1 /192nd of such cost for each
full month of this Lease prior to the notice of termination. If
Lessor fails to commence the erection of the private commercial
or residetial building within thirty (30) days after Lessee
removes i e Lessee shall again have the right to occupy
the premises and maintain advertising signs subject to the
provisions of this Lease. If any portions of the property are
not to be utilized for such building, the Lessee has the option
to use the remaining portion on the same terms, except that the
rent shall be proportionately reduced.
7. It is agreed between parties that Lessee, or such person
as the case may be, shall remain the owner of all of said
advertising signs, structures, and improvements, and that,
notwithstanding the fact that the same constitute real estate
fixtures, the Lessee, as the case may be, shall have the right to
remove said signs, structures and improvements at any time during
the term of this Lease, or after the expiration of this Lease.
8. The location and height of the sign shall be at the most
feasible location possible and is to be agreed upon by both the
Lessee and Lessor prior to construction. In no event will the
bottom of Ackerley's sign be low enough to obstruct the .
visibility of the existing KFC signage and bucket package.
9. Lessee 'agrees to construct and rotate sign before KFC's
normal business hours. If, for some chance additional time is
needed, Lessee agrees to consult on site store manager and
arrange a schedule which is agreeable by both parties.
10. At the expiration of this lease, absent of any renewal
or extension thereof, Lessee is to remove the sign from Lessor's
property and restore the property to it original condition prior
to sign erection. All such removal and restoration costs shall
be incurred by the Lessee.
11. No copy will be posted on said structure that may be
considered as competition to KFC.
12. Lessee will provide and consume all costs relating to
the illumination of its structure.
13. All structures erected by the Lessee shall be maintained
in a clean and neat manner.
14. This lease shall constitute the sole agreement of the
parties relating to the lease of the above described premises.
Neither party will be "bound by any statements, warranties, or
promises, oral or written, unless such statements, warranties or
promises are set forth specifically in this Lease.
15. The word "Lessor" as used herein shall include lessor.
This Lease is binding upon and inures to the benefit of the
heirs, executors, successors and assigns of the Lessee and
Lessor. •
16. Lessor represents that he is the tenant of the-property
covered by this Lease and has the authority to execute this
Lease. All rents to be paid pursuant to this Lease, and all
notices are to be forwarded to the undersigned Lessor at the
address noted below the Lessor's signature.
EXECUTED by the Lessor in the presence of w
rviele � � �/�
who is hereby retuested to sign as
witness.
WITNESS: Les-..(s)
✓ ,-. L' _ X ► , . date / / 44
ACCEPTED: X date
ACKERLEY COMMUNICATIONS
Kentucky Fried Chicken oP Ca :���'^ ia ) J1
3100 Lake Center Drive
Suite 200
Santa Ana, CA 92704 -5943
By:
Tax YD# _ - 34 7 Sr'
Title:
4.
n\c\ 3--CILC 1143 c.
WASHINGTON COUNTY ELECTRICAL PERMIT
Department Land Use & Transportation
Electrical Inspection Section
1i •
n
155 North First Avenue, #350-12 APPLICATION
Hillsboro, Oregon 97124
Information: (503) 640-3470 Fax: (503) 693-4412 T
Permit C V
PLEASE PRINT Number Date
Please complete all sections, 1 through 5. 4, Complete Fee Schedule below
Number of inspections per permit allowed
1. Location of installation
Address I}-4 -� Cul) 't1-4*t_. 'x-i L-~) Service included: Items Cost(ea.) Sum
Building A. Residential-per unit
City'-1'cv.,a-cl. Suite No.
1000 sq.ft.or less $110.00 4
Tenant Name additional 500 sq.ft
(if commercial) .� E t or portion thereof $25.00
Map No. � ' _ Tax Lot ,1 i. Limited Energy $25.00 1
Each Manuf'd Home or Modular
Thomas Ma Book: Page: --1.)--)____--- Section: .-t Dwelling Service or Feeder $68.00 2
Directions i ( bc,�_�
B. Services or Feeders
Installation,alterations or relocation
200 amps or less $60.00 2
Commercial Residential 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
2a. Contractor installation onl 601 amps to 1000 amps $180.00 2
Over 1000 amps or volts $340.00 2
Electrical C,,..QQntractor 6-t-c- ( ('. , Reconnect only $50.00 2
Addre O , c K I
City o u-t State{')k--( ZIP 9.7'7..4 C C. Temporary Services or Feeders
''
Date 2---2-) C i`} Job Number I q 3 c Installation,alteration or relocation
Property Owner 200 amps or less $50.00 2
Contractor's License No. Cla S .- C- 201 amps to 400 amps $75.00 2
n 401 amps to 600 amps $100.00 2
Contractor's Board Reg. No. V--( 7 Over 600 amps to 1000 volts see•e•above
4
Signature of Su_pr. Elec'n L- �'�c4 �2.-t,, D. Branch Circuits
License No. ..i i.-c) Phone N D- Ci-r`, S�_( New,alteration or extension per panel
a) The fee for branch circuits with
2b. For owner installations: purchase of service or feeder fee.
Each branch circuit $5.00 2
Print Owner's Name Phone No. b) The fee for branch circuits without
purchase of service or feeder fee. ,
Address First branch circuit $35.00 `-' 2
Each add'nl branch circuit / $5.00 2
City State Zip E. Miscellaneous (Service or Feeder not included)
Each pump or irrigation circle $40.00 2
The installation is being made on property I own Each sign or outline lighting $40.00 2
which is not intended for sale, lease or rent. Signal circuit(s)or a limited
energy panel,alteration
Owner's Signature or extension $40.00 2
F. Each additional inspection over the allowable
in any of the above
3. Plan Review section (if required) Per inspection $35.00
Per hour $55.00
Please check appropriate item and enter fee in section 5B. In Plant $55.00
4 or more residential units in one structure 5. Fees +
Service and feeder, 800 amps or more
System over 600 volts nominal A. Enter total of above fees $ </`
e
Classified area or structure containing special 5% Surcharge (.05X total fees) $ --
occupancy as described in N.E.C. Chapter 5 Subtotal $
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $
above apply. Not required for temporary construction Subtotal $
services. ❑ Trust Account $
Balance Due $ '
For inspections call This permit becomes null and void if the work authorized by the permit is not commenced
640-3561 or 693-4415 within 180 days from date of issuance of such permit or if the work authorized is
suspended or abandoned at any time after work is commenced for a period of 180 days.
24-hour recorder, one working day in advance of need Electrical Permits are non-refundable and non-transferable.
8/94
DEPARTMENT OF LAND USE&TRANSPORTATION
411Mik WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILLSBORO,OR 97124
COUNTY, INSPECTION REQUESTS: 503/640-3561/693-4415
OREGON XXXXXXXXX--> 640-3470
Page : 1 of 1
Date : 03/01/95
Time : 16 : 34
Permit Type : Residential Electrical Permit Permit # : 05064502
Permit Status : APPROVED Applied : 03/01/95
Situs Address : 11425 SW PACIFIC HW Ti Issued : 03/01/95
Permit Title : SFR - 2 BRANCH CIRCTS Completed :
Permit Descr. To Expire : 08/28/95
Project Title : SFR - 2 BRANCH CIRCTS Project # : P0047930
Project Descr. * EROSION *
•
Parcel Number : 2S1TI - Land Use District :
Valuation 0
Legal Descr. .•
Owner : INSPECTION - TIGARD Construction : OTH
Applicant Name : GRAND ELECTRIC Classification : 900
Applicant Addr. : PO BOX 12253 Occupancy : R3
PORTLAND, OR 97212 Validated by : LG
Applicant Phone : 234-9329 inspector Area :
Fee description Units Fee/Unit Ext fee Data
1st Branch W/out Feeder [Enter #] 1 35 . 00 35 . 00
Addl . Branch W/out Feeder [Enter #] 1 5 . 00 5 . 00
Subtotal Electrical Fees : 40 . 00
State Surcharge of 5% 2 . 00
Total Electrical Fees : 42 .00
*** Fees Required *** *** Fees Collected & Credits ***
Method Check # Receipt No. Date Payment
CK 3561 03/01/95 42 . 00
"L'O'YAL THIS DATE ********* 42 . 00
Fees : 42 . 00
Adjustments : . 00 Total Credits: . 00
Total Fees : 42 . 00 Total Payments : 42 . 00
Balance Due : . 00
•
NOTICE: This permit becomes null and void if the work or construction for which it is issued is not commenced within 180 days. Once construction has started,
the permit becomes null and void if construction is interrupted for a period of 180 days. I certify that the information presented by the applicant and
his agent or agents in support of this permit is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading information may invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for inspections at various times during the process of construction and the building
inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department is solely at the risk of the applicant and such use or occupancy is revocable until all inspection requirements are satisfied and
approval is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit is issued
specifying that the use or occupancy of the building or structure is provisional and revocable until the satisfaction of all inspection requirements.
APPLICANT'S SIGNATURE