SGN2001-00215 CITY OF TIGARD SIGN PERMIT
g n � � DEVELOPMENT SERVICES
PERMIT #: SGN2001 -00215
��� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4 DATE ISSUED: 11/15/2001
EXPIRATION DATE:
BUSINESS NAME: IMPRESSIONS DANCE CLUB
SIGN LOCATION: 14363 SW PACIFIC HY PARCEL: 2S110AB -00201
W
APPLICANT /AGENT: ZONE: C -G
BUSINESS TAX NO: JURISDICTION: TIG
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 2' X 12'
TOTAL SIGN AREA: 24 sq. ft.
WALL AREA: 2,500 sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Temporary placement of (1) banner sign. Valid 11/16/01- 12/16/01 (Sign #1)
MATERIALS: BANNER
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 15.00
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 ► will be done in accordance with approved plans. A sign permit shall expire 90
days from approval date. A temp • - sign shall expire .1 days from approval date. A balloon sign shall expire 10
days fmm annmval date /
•
APPROVED BY: ' jO �� , ' /
PERMITTEE SIGNATURE �'_
DATE: 11/15/211
4 , ,, i . . „ 1,; ,, 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
s
Site /� 6 Ilk - ►•-- A .
t reet ".ress ■ Permit No.: i■ .3_1_11 1 #1.0.
Location /C13(1.3 /� �����
� / r �.� Expiration • Date. I�r7J''7�Of:`wfll�] a
Suite /Bldg. # City /St FIP
Receipt #: . ji
Name � �Q • ! Approved By: &
/
�, Date: 1t • t
9
Property (1/ e�- G v-�
Owner Mailing Addres Suite Map/TL #. _ 4 t O/2. � ��
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9
Zonin : C — i
City/Stat- Zip 4 Phone
Aro t� i � Electrical Permit Required? ❑Yes No
Tenant or �'�me �� G C -1 Building Permit Required? ❑ Yes No
Business
N. e , Rev: 30 -Jul -01 hcurpin\masters\revised\sign permit app.doc
Sign
C REQUIRED SUBMITTAL ELEMENTS
Contractor Mailing Address Suite
(Prior to permit I {�' 4.......__ (Note: applications will not be accepted
issuance, a / 2 �w [� without the required submittal elements)
copy of all City/State Zip P one
licenses are !-6 ,-� -)- d - - Co leted
required if P Application Form
expired in the ■regon 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)
size requirement: 81/2" x 11 ", or 11" x 17"
Proposed ❑ Permanent ❑ Freestanding ❑ Freeway
Sign Q�r�porary ❑ Wall ❑ Electronic ❑ 2 copies of elevations, drawn to scale
(Check all that Other ❑ Billboa ❑ Balloon (3 copies, ff a building permit is required)
app size requirement 81/2" x 11 ", to 24" x 36'
❑ New sign? Alter to existing sign? ❑ $50.00 Fee (Permanent sign, any size)
Sign Dimensi ns:
Z ❑ $15.00 Fee (Temporary sign, any type)
Total Sign Area (sq. ft.):
p NOTES:
Data Total Wall Area (sq. ft.) ,cl • Wall signs do not need to be drawn to scale,
Sign D but must include dimensions of wall face and
(Complete all Direction Wall Faces (circle one): sign placement.
items in this Wall signs do not require site /plot plans.
section) N S E�E NW SE SW • Freestanding signs over 6 ft. required a
Height to top of sign (feet): building permit.
Projection From Wall (inches): • If work authorized under a sign permit has not
Copy: been completed within ninety (90) days after
Materials: • the issuance of the permit, THE PERMIT WILL
BECOME NULL AND VOID.
Will sign have illumination? ❑ Yes o
Type: ❑ Internal ❑ External
Are there any existing freestanding or wall signs at this 1Not all jurisdictions accept credit cards, please call jurisdiction for more information.
❑ Visa ❑ MasterCard
location, including wall signs that overlap a tenant space?
Credit card number
�
es ❑ No Expires
"yes ", a list or diagram of all sign dimensions and Name of cardholder as shown on credit card
square footage must also be submitted. Amount
Cardholder signature
(OVER FOR SIGNATURES)
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Receipt #: 27200100000000004533
Date: 11/15/2001
T I D E M A R K
COMPUTER SYSTEMS, INC
Line Items: -
Case No Tran Code Description Revenue Account No. Amount Due
SGN2001 -00215 [SIGN] Temp Sign Perm 100 - 0000 - 437000 $15.00
SGN2001 -00216 [SIGN] Temp Sign Perm 100 - 0000 - 437000 $15.00
Payments:
Method Payer Bank No Acct Check No Confirm No. Amount Paid
Check IMPRESSIONS DANCE CLUB 0 2490 0 $30.00
TOTAL AMOUNT PAID: $30.00