SGN2004-00255 A CITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2004 -00255
a,��� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/22/2004
PARCEL: 1 S 135BD -00300
BUSINESS NAME: HORIZON PEDIATRICS ZONE: C -G
SIGN LOCATION: 09735 SW SHADY LN 3RD JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 2' -4" X 8'0
TOTAL SIGN AREA: 19 sq. ft.
WALL AREA: 4,800 sq. ft.
WALL FACE (DIRECTION): N
SIGN HEIGHT: 22 ft.
PROJECTION FROM WALL: 1 in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Installation of (1) 19.2 sq ft permanent wall sign.
MATERIALS: ALUMINUM
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 32.00
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 II expire. A temporary sign shall expire 30 days from validity
date. A balloon sign shall expire 10 d•.�•�'' validity date.
APPROVED BY: /`��'
PERMITTEE SIGNATURE: `
DATE: 9/22/2004
I
,
ii-s. 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 � � FOR STAFF USE ONLY
Address/ Street Address _ q/� �f sti / 00 Z 55
Location q 7 / IAAA
Permit No.: W -�
Suite/Bldg. # city /Stat r'� Lp Expiration Date:
3 v v - 16M 6 1'77 3 Receipt #: �-`,�o �/, 3
Name Approved By
Property –4 `�u � Date: /2
Owner Mailing Address Suite Map/TL #:
471 Sctifiel4 W W. g t Zoning: / 6C C
City/ Zip Phone
lC otui/ i
Electrical Permit Required?
Tenant or Name q ❑Yes ❑ No
Business g16 (J(jrSefls Building Permit Required? ❑ Yes ❑ No
Name Rev. 8/7/2003 is \curpin\masters \revised\sign permit app doc
s
Sign 6\)J COW v
Contractor Mailing Address Suite
(Prior to permit 1(�1 ' �1 REQUIRED SUBMITTAL ELEMENTS
issuance, a 1 ! (Note: applications will not be accepted
copy of all City /State Zip Phone without the required submittal elements)
licenses are, �y „ � v �� �� / � I
required a if
i•z/ di ""mi �
l
expired in the Oregon Const. Cont. Board Exp. Date ❑ Completed Application Form
City of Tigard's license # �
database) ti sS L ( Cl ,_,, ZZ ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
Proposed (3 copies, if a building permit is required)
Si n �-. P ermanent ❑ Freestanding El Freeway size requirement: 8 x 11", or 11" x 17"
g ❑ Temporary wall ❑ Electronic
(Check all that ❑ Other ❑ Billboard ❑ Balloon El copies of elevations, drawn to scale
apply)
(� New sign? (3 copies, if a building permit is required)
g ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions: . •. X "' .4c)
❑ $3,00 Fee (Permanent sign, any size)
Total 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):
items in this NOTES:
section) 4ht S E W NE NW SE SW
to top of sign (feet): ZZ' • Wall signs do not need to be drawn to scal
Projection From Wall (inches): but but must include dimensions of wall face and
Co py p sign placement.
• Wall signs do not require site /plot plans.
Materials: k 6p/M- S M • 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 11 No BECOME NULL AND VOID.
If "yes ", a list or diagram of all sign dimensions and
square footage must also be submitted.
/ G.(\) q41 h n 114 ,� 5 34 (OVER FOR SIGNATURES) ellin
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.
,
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DATED this / 1 day of , 20 Li
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Signature 5 Owner /A•, nt
A-C1W Stjr (02 I t C V
Contact Person Name Phone No.
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Conditionally Approved [ f , 4• a . ` \\ � � � ' naL.
For only the ^.rork described
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