SGN2004-00158 jj''��l)la 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 FOR STAFF USE ONLY
Site 01 (t I) JIt
Address/ Street Address / Permit No.: SG N a-�v `F' o /-8
Location / 1 5 2 - S — S ' J X6-11 ' 12d Expiration Date: / - /3 - o S
Suite /Bldg. # City/State Zip a 0 3 / Yo2
J lV G / -11 - Receipt #:
Name Approved By: C__- C .eo
Property �s ch ✓ice -' p'g''," Date: '7 - lqr 0'4
Owner
ii y r\ ress Suit= / Map /TL #: 02 S // o O C - v.1300
IJ "' b ad a- - 7 0 7 Zoning: C " &
City/State Zip Phone
P-4
.1 Iron d '17 5 ` 3 y.1 )-5ci, Electrical Permit Required? ❑ Yes ❑ No
Tenant or Name,
Business R ,,i, ,42 J , hy ph lC'. rr DS Building Permit Required? ❑ Yes ❑ No
W
Name U / Rev. 01 -Jul -02 is \curpin \masters \revised \sign permit app.doc
Sign
C REQUIRED SUBMITTAL ELEMENTS
Contractor Mailing Address Suite
(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 KLTemporary ❑ Wall ❑ Electronic
(Check all that Other ❑ Billboard ❑ Balloon El 2 copies of elevations, drawn to scale
apply) (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:
❑ $30.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.):
/2 ❑ $15.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.)
(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: 1 • Wall signs do not require site /plot plans.
Materials: • Freestanding signs over 6 ft. required a
building permit.
Will sign have illumination? ❑ Yes ❑ No 1 • 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 0 N
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 I day of J ` , 20 C
Signature of Owner /Age
C OA-0-a- / A 5 arD -x/
Contact Person Name Phone No.
CITY OF TIGARD 7/19/2004
13125 SW Ha11 Blvd. 3:01:19PM
&m„r,d� Tigard, Oregon 9 72 23
(503) 63 9-4 17 1
Receipt #: 27200400000000003142
Date: 07/19/2004
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2004 -00154 [SIGN] Temp Sign Perm 100 - 0000 - 437000 15.00
SGN2004 -00155 [SIGN] Temp Sign Perm 100 - 0000 - 437000 15.00
SGN2004 -00156 [SIGN] Temp Sign Perm 100- 0000 - 437000 15.00
SGN2004 -00157 [SIGN] Temp Sign Perm 100- 0000 - 437000 15.00
SGN2004 -00158 [SIGN] Temp Sign Perm 100- 0000 - 437000 15.00
Line Item Total: $75.00
Payments:
Method Payer User ID Acct. /Check Approval No. How Received Amount Paid
Check CURVES OF TIGARD CAC 1627 In Person 75.00
Payment Total: $75.00
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