SGN2004-00316 CITY TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2004 -00316
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/27/04
PARCEL: 1S136DB-00201
BUSINESS NAME: FRED MEYER ZONE: C -G
SIGN LOCATION: 11565 SW PACIFIC HWY JURISDICTION: TIG
APPLICANT /AGENT: FRED MEYER (TIGARD STORE)
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: FREEWAY:
TEMPORARY: X WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 2' X 4'
TOTAL SIGN AREA: 16 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of one temporary A- frame. Sign #1. Valid from 11/3/03 through
12/3/04.
MATERIALS: 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.
APPROVED BY:
PERMITTEE SIGNATURE: -' e ''y ` .4--
DATE: 10/27/04
i, 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 J- /e( r V le ye,--,5- FOR STAFF USE ONLY
�( Address/ Street Address Permit No.: NJ �ckY { O
(� (33/y,
' \ Location / /c"( SGL) . _Si-6 C r
Suite /Bldg. # City /State / y� g722_,3 Zip / Expiration Date: 1a-3 —o�
I ll ,( C /�' Receipt #: 0200 4 — &f7 o 9
Name ' Approved By: 0. Ca "1n
Property -ed / / K yens S ,L c Date: /D _� 7 — o
y Owner Mailing Address Suite Map/TL #: 16 13 Z B — 6o ao
13 Ly g 2/2/ Zoning: C — G
City /State Zip Phone
Fe /j t)n ')172 z Electrical Permit Required? ❑ Yes No
YTenant or ame
Business Building Permit Required? ❑ Yes X No
Name Rev. 7/1/04 i:\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 Ci .. e Zip Phone
licenses are
I
required if ❑ Completed Application Form
expire• ' the Oregon Const. Cont. Board Exp. Date
Ci of Tigard's License # ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
•atabase) (3 copies, if a building permit is required)
Proposed rmanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11", or 11" x 17"
Sign Temporary ❑ Wall
❑ Electronic ❑ 2 copies of elevations, drawn to scale
(Check all that
apply) ❑ Other ❑ Billboard ❑ Balloon
(3 copies, if a building permit is required)
❑ New sign? ❑ Alter to existing sign? i size requirement: 8 x 11", to 24" x 36"
ign Dimensions:
El $32.00 Fee (Permanent sign, any size)
�� �� ?
otal Sign Area (sq. ft. : ❑ $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
Height to top of sign (feet): • Wall signs do not need to be drawn to scale, 1
but must include dimensions of wall face and
Projection From Wall (inches): sign placement.
Copy: • Wall signs do not require site /plot plans.
' aterials: lk.960X1, i - Ives • 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
❑ Yes ❑ No BECOME 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.
DATED this day of , 20
%X
ignature of Owner /Ag nt
Contact Person Name Phone No.
CITY OF TIGARD :.
13125 SW Hall Blvd.
Tigard, Oregon 9 72 23
a''h ` (503) 639 -4171
Receipt #: 27200400000000004709
Date: 10/27/2004
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2004 -00316 [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
CreditCard KADRAN MULOCK CAC 018768 In Person 15.00
Payment Total: $15.00
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