SGN2001-00216 CITY OF TIGARD SIGN PERMIT
i DEVELOPMENT SERVICES PERMIT #: SGN2001 -00216
r 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/15/2001
EXPIRATION DATE:
BUSINESS NAME: IMPRESSIONS DANCE CLUB PARCEL: 2S110AB -00201
SIGN LOCATION: 14363 SW PACIFIC HWY
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 12/17/01- 1/17/02 (Sign #2)
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 , • rk will be done in - ccordance with approved plans. A sign permit shall expire 90
days from approval date. Ate' po cry sign shall ex • r= 30 days from approval date. A balloon sign shall expire 10
days fmm annrnval riatP /
APPROVED BY: - --�. =`� �'�
PERMITTEE SIGNAT j =�'
: : -'-/15/2001
ij
ity iii. 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/Prrojeect FOR STAFF USE ONLY
Site � � 5�`" � I ), .--'
Address/ t re t ress Permit No.: it .,a — a* 4! Location 3i MA ., Expiration Date: 1A. V N — 1 t
Suite /Bldg. # City /St i' ip
� I i OQ . / Receipt #: • lad mi
Name Approved By:
Property ll/
/ �, Date: ��
cam xi, s — —
Owner Mailing Address Suite Map/TL # :_ -J 0
Zoning: —
City/Stat - Zip Phone
- g Electrical Permit Required ❑ Yes E,No
Tenant or me ,, /
Business
� �1 A/6,1_
Building Permit Required? 1:1 Yes No
N. e Rev. 30-Jul -01 ilcurp1Mmasters\revised\sign permit app.doc
Contractor Ma g Address • Suite REQUIRED SUBMITTAL ELEMENTS
Contractor
(Prior to perm L�5 32 cif V , � (Note: applications will not be accepted issuance, a U without the required submittal elements)
copy of all City/ Zip Zip P one w 3 licenses r are q , ,��/ / \ � 2 2t � �r� ' Completed Application Form
required if LL /�� l /flJd C�1J 6
expired in the regon Const. Cont. Board Exp. ate
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 (� porary ❑ Wall ❑ Electronic ❑ 2 copies of elevations, drawn to scale
(Check all that v rj Other ❑ Billboa ❑ Balloon (3 copies, if a building permit is required)
apply) _ size requirement: 8 11", to 24" x 36"
❑ New sign? Alter to existing sign? ❑ $50.00 Fee (Permanent sign, any size)
Sign Dimensi ns: I ( r) ❑ $15.00 Fee (Temporary sign, any type)
Total Sign Area (sq. ft.): �`
p NOTES:
• Sign Data Total Wall Area (sq. ft.) �- .6� ♦ Wall signs do not need to be drawn to scale,
Sig but must include dimensions of wall face and
(Complete all Direction Wall Faces (circle one): sign placement.
items in this
section) N S E,4;3i NW SE SW ♦ Wall signs do not require site/plot plans. •
• 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 Jam-' "
Type: ❑ Internal ❑ External //
Are there any existing freestanding or wall signs at this (Not all jurisdictions accept credit cards, please call jurisdiction for more information.
y g 9 ❑ visa ❑ MasterCard
location, including wall signs that overlap a tenant space? 1
Credit card number
�
es ❑ No Expires
If "yes ", a list or diagram of all sign dimensions and Name of cardholder as shown on «edit 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
Signature of Owner /Agent
Contact Person Name Phone No.
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Receipt #: 27200100000000004533
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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