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SGN2009-00192 SIGN PERMIT CITY OF TIGARD Permit #: SGN2009 -00192 COMMUNITY DEVELOPMENT Date Issued: 08/31/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103DD00800 Jurisdiction: Tigard Name of Business: Business Address: 13815 SW PACIFIC HWY 80 Applicant/Agent: Tigard Donut, Work Description: Placement of 1 temporary sign (A- Frame) 36" X 48" Valid 9/1/09 to 10/1/09 Sign #3 Must be placed on private property, not in public right -of -way. Must meet visual clearance area requirements. Permanent: No Freestanding: No Freeway: No Temporary: 3 Wall: No Electronic: No Billboard: No Balloon: No Banner: No A- Board: Yes Sign Dimensions: 3 X 4 ft Total Sign Area: 12 Wall Area: Wall Face (Direction): Sign Height: ft. Projection From Wall: in. Illumination: No Illumination Materials: Wood Electrical Permit Required: No Building Permit Required: No Total Permit Fee: $19.00 Conditions: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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. 'Y � /milP Approved By: pP Permittee Signature: • SIGN PERMIT APPLICATION City of Tigard Permit Center 13125 SW" Hall Blvd, Tigard, OR 97223 - Phone: 503.639.4171 Fax: 503.598.1960 T CARD F I GENERAL INFORMATION 1 Name of Development /Project FOR STAFF USE ONLY Site ,, I Address/ Street Address �� OW \ PePermit t�°J/U ut No.: 5 OR'00 Z Location /381 5 � Pet c d 1 I Suite /Bldg. # City /State Zip Expiration Date: tOt l l 0 R aO 1 ( k 7/7.2.2_? Receipt #: Name 1(/ r5 Approved By: Property Ant S t U de r5 Date: SI?jl O Owner Mailing Address Suite Map /TL #: . .51 03 P 2 ©og'O Zoning: City/State Zip Phone Electrical Permit Required? ❑ Yes ❑ No Tenant or Name Business i ccoOti'-Ci DO n eri Building Permit Required? ❑ Yes ❑ No Name Rev. 7/1/09 is \curpin \ masters \land use applications \sign permit app.doc Sign Contractor Mailing Address Suite (Prior to permit issuance, a REQUIRED SUBMITTAL ELEMENTS copy of all City/State Zip Phone licenses are (Note: applications will not be accepted required if without the required submittal elements) expired in the Oregon Const. Cont. Board License # Exp. Date City Tigazd °s database) El Completed Application Form dat Proposed ❑ Permanent ❑ Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale Sign g Temporary ❑ Wall ❑ Electronic (3 copies, if a building permit is required) (Check all that ❑ Other ❑ Billboard ❑ Balloon size requirement: 8 x 11 ", or 11" x 17" apply) ❑ New sign? E ' Alter to existing sign? ❑ 2 copies of elevations, drawn to scale Sign Dimensions: (3 copies, if a building permit is required) size requirement: 8 x 11 ", to 24" x 36" Total Sign Area (sq. ft.): X� ❑ $40.00 Fee (Permanent sign, any size) Sign Data Total Wall Area (sq. ft.) ❑ $19.00 Fee (Temporary sign, any type) (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, but Projection From Wall (inches): must include dimensions of wall face and sign placement. Copy: r ♦ Wall signs do not require site /plot plans. Materials: wC)v ( ♦ Freestanding signs over 6 ft. required a building Will sign have illumination? Yes ❑ No permit. Type: ❑ Intemal ' External ♦ If work authorized under a sign permit has not been Are there any existing freestanding or wall signs at this location, completed within ninety (90) days after the issuance including wall signs that overlap a tenant space? of the permit, THE PERMIT WILL BECOME ❑ Yes ❑ No NULL AND VOID. If "yes ", a list or diagram of all sign dimensions and square footage must also be submitted. . (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. DA1'r,D this 3 / day of A (Ar , 20 0 ignature of Owner /Agent F gee- � ;,�► - --- a �,3 Contact Person Name Phone No. 1 C ) CITY OF TIGARD RECEIPT 1 1 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 •T]IGARD Receipt Number: 175039 - 08/31/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SGN2009 -00192 Temp Sign Perm 1003100 -43115 $17.00 SGN2009 -00192 Temp Sign Perm - LRP 1003100 -43117 $2.00 Total: $19.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Cash STREAT 08/31/2009 $19.00 Payor: Tigard Donut Total Payments: $19.00 Balance Due: $0.00 Page 1 of 1