SGN2013-00120 APPLICANTS:
To consider an application complete, you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as described on the
front of this application in the "Required Submittal Elements" box.
NOTE: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for work.
* When the owner and the applicant are different people, the applicant must be the purchaser of record or a lessee in possession with
written authorization from the owner or an agent of the owner. The owner(s) must sign this application in the space provided on the back
of this form or submit a written authorization 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, attachments, and exhibits 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.
♦ 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 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.
SIGNATURES of each owner of the subject property are required.
Applicant Signature Date
Signature of Owner /Agent Date
Contact Person Name Phone No.
City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 I www.tigard - or.gov I Page 2 of 2
cozy NAILS & S
• Manicure $15
• Spa PCdi $20
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• Shellac Mani $25
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• Full Set $25
• Fill -Ins $1
503- 598 -6800
Walk -Ins Welcome
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CITY OF TIGARD
Approved [>"'t
Conditionally Approved _ . _..___._ [
Qrk� as described i n:
PERMIT For only N0thew bI\2 oI cOt ? D
See Letter to: Follow..._. ..___.. _ .— •- ..••.•• [ J
Attach [ ]
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