SGN2004-00142 CITY TIGARD SIGN PERMIT
'111 DEVELOPMENT DEVELOPMENT SERVICES PERMIT #: SGN2004 -00142
' ���1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/2004
PARCEL: 2S 103 D D -00800
BUSINESS NAME: JAVA JUICE ZONE: C -G
SIGN LOCATION: 13815 SW PACIFIC HWY 80 JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: Y FREEWAY:
TEMPORARY: X WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3'X 4' PER FACE
TOTAL SIGN AREA: 24 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: 4 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of (1) one temporary A -frame sign. Sign must be placed on private
property and not in the public right -of -way or visual clearance area. Valid 6/29/04
- 7/29/04. Sign #3
MATERIALS: WOOD
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 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 s fr m validity date.
APPROVED BY. ' � ��
PERMITTEE SIGNATURE: cMl-f At r
DATE: 6/29/2004
ll 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
Site 'mi �
/91i8 FOR STAFF USE ONLY
Address/ Street Ad ress Permit No.:,5 ( -) N 2 --0jt -- k t y
Location 13 ( /5- C i w r ei'fct
Suite /Bld . # City /State Zip
Expiration Date: qZ f() ( ( - �l 7
0 1Z6 4r- .1g-3 Receipt #: 0 t • —,2 a/ 0
Name ' / ��,/ ' Approved By
Property V�mac V (t��i0 Date: (olLc :/
Owner Mailing Address Suite Map /TL #: 25 i 63 J 0 - 0Z;
emo i/nAap 1 ) D 1 Zoning: C9
City /State Zip Phone / pp
P f )R l ? V4 Rt g g93- .vM2 Electrical Permit Required? ❑ Yes EL-No
Tenant or Name
Building Permit Required? ❑ Yes Q No
Business
Name Rev. 7 /1/04 is \curpin\ masters \revised \sign permit app.doc
Sign
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuance, a without the required submittal elements)
copy of all City /State Zip Phone
licenses are
required if ❑ Completed Application Form
expired in the Oregon 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)
Proposed ❑ Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11", or 11" x 17"
Sign Temporary ❑ Wall ❑ Electronic
(Check all that Other El 2 copies of elevations, drawn to scale
apply) ❑ Billboard ❑ Balloon (3 copies, if a building permit is required)
[' New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions: 3 X ( / � ❑ $32.00 Fee (Permanent sign, any size)
/
Total Sign Area (sq. ft.): , S¢ 111 $15.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) / Jurisdiction: ❑ City ❑ Urb
(Complete all Direction Wall Faces (circle one): NOTES:
items in this
section) N S E W NE NW SE SW
• Wall signs do not need to be drawn to scale,
Height to top of sign (feet): but must include dimensions of wall face and
Projection From Wall (inches): sign placement.
Copy: • Wall signs do not require site /plot plans.
Materials: • Freestanding signs over 6 ft. required a
Will sign have illumination? ❑ Yes ' No building permit.
Type: ❑ Internal ❑ External • If work authorized under a sign permit has not
Are there any existing freestanding or wall signs at this been completed within ninety (90) days after
location, including wall signs that overlap a tenant space? the issuance of the permit, THE PERMIT WILL
BECOME NULL AND VOID. '
0 Yes I=1 No
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.
DATED this day of D
, 20
YP' /
Signature of Owner /Agent
y9 /i �o3)
Contact Person Name hone No.
l 3 - t
-\ 6
6,U ._' CITY OF TIGARD
Approved [ )
Conditionally Approved [ �
Li- For only the wofk as described in:
--'�� 1- G� PERMIT NO. ,>9A1 4' 'L
See Letter to: Follow [ l
Attach
Job Addre
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77 /747.
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1 1 .JL j1.jjiJXj LP 6/29/2004
13 12 5 SW Hall Blvd.
11:01:44AM
Arphv Al Tigard, Oregon 9 72 23
' (503) 63 9-4 17 1
Receipt #: 27200400000000002810
Date: 06/29/2004
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2004-00142 [SIGN] Temp Sign Perm 100-0000-437000 15.00
Line Item Total: $15.00
Payments:
Method Payer User ID Acct./Check Approval No. How Received Amount Paid
Cash JAVA JUICE KJP In Person 15.00
Payment Total: $15.00
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