SGN2005-00163 % .
CITY OF TIGARD SIGN PERMIT
i DEVELOPMENT SERVICES PERMIT #: SGN2005 -00163
II I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/6/2005
PARCEL: 2S1 12 D D - 00 300
BUSINESS NAME: SHELL FOOD MART & GAS ZONE: I -
SIGN LOCATION: 15900 SW 72ND AVE JURISDICTION: TIG
APPLICANT /AGENT: SHELL FOOD MART
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3' X 4'
TOTAL SIGN AREA: 12 sq. ft.
WALL AREA: 750 sq. ft.
WALL FACE (DIRECTION): N
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: P
MATERIALS: VINYL /WOOD
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. 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.
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APPROVED BY: Cy" "",,
PERMITTEE SIGNATURE: 1 ' f ` /P
DATE: 6/6/2005
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44.,,01A- SIGN PERMIT APPLICATION
CITY OF TIGARD 13125 SW Ha11 Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name of Development/Project
Site 5ke l ( I UM (1
'ham ( FOR STAFF USE ONLY
Address/ Street Address Permit No.: . (,A1.,oaS - 00 i (,, 3
A Location X5 5&) (,(46 I' 1 P5 /pix7'a
Expiration Date:
Suite /Bldg. # City /State Zip
2
TtG I)
t�n 0
9 7,223 Receipt #: . 'a •-a5ys'
Name Approved By: C - ( t _
Property —7 7) 4 1e C' L- Cow(pi,o Date: to-lo-OS
Y Owner Mailing Address uite Map/TL #: QSi l a DO - -0C.3 G)J 1 5 - i c o 54J O p / M 6,04-5 / 7 Zoning: 1 - L
City /State Zip y Phone �y
Tt isaf� 6e 972,23 SU / 6.2o -/ 717
enant or Name Electrical Permit Required? Li Yes No
usiness Ske (( F°0 ( !M (� e 5tlP (( G� i- Building Permit Required? ❑ Yes US No
Name Rev. 1/3/05 is \curpin \masters \revised \sign permit app.doc
Sign
Contractor Mailing Address , uite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit — � (Note: applications will not be accepted
issuance, a
copy of all City /Sta zip Phone without the required submittal elements)
licenses are
required if % � ❑ Completed Application Form
expired i e Oregon Const. Cont. Board Exp. Date
Cit igard's License #
tabase) El 2 Copies of Site /Plot Plan, Drawn to Scale
(3 copies, if a building permit is required)
Proposed Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign Temporary ❑ Wall ❑ Electronic
(Check all that ❑ Other ❑ Billboard ❑ Balloon ❑ 2 copies of elevations, drawn to scale
apply) (3 copies, if a building permit is required)
❑ New sign? ❑ After to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimension
�,X` - { s: 1 ❑ $37.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.):
(,2 ❑ $17.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft �5 Jurisdiction: ❑ City ❑ Urb
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S E W NE NW SE SW
Height to top of sign (feet): • Wall signs do not need to be drawn to scale,
_
Projection From Wall (inches): but must include dimensions of wall face and
sign placement.
Copy: • Wall signs do not require site /plot plans.
Materials: • Freestanding signs over 6 ft. required a
Will sign have illumination? ❑ Yes ❑ building permit.
No • If work authorized under a sign permit has not
Type: ❑ Internal ❑ External been completed within ninety (90) days after
Are there any existing freestanding or wall signs at this the issuance of the permit, THE PERMIT WILL
location, including wall signs that overlap a tenant space? BECOME NULL AND VOID.
❑ Yes ❑ No
If "yes ", a list or diagram of all sign dimensions and
square footage must also be submitted.
(OVER FOR SIGNATURES)
• . 1
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
Y 11 14
Signature f- wner /Agent
Contact Person Name Phone No.