SGN2004-00276 CITY OF TIGARD SIGN PERMIT
Tr DEVELOPMENT SERVICES PERMIT #: SGN2004 -00276
����1, 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/29/2004
PARCEL: 2S 110AA -00500
BUSINESS NAME: FARMERS INSURANCE ZONE: C -G
SIGN LOCATION: 10580 SW MCDONALD ST 105 JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: FREEWAY:
TEMPORARY: X WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3'X6'
TOTAL SIGN AREA: 18 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placment of (1) 18 sq. ft. banner. Valid 10 -11 -04 thru 11/10/04. Sign #2
MATERIALS: CANVAS
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 Speaalty 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 si• n permit shall expire. A temporary sign shall expire 30 days from validity
date. A balloon sign shall expire 10 days fro, :lidity date.
APPROVED BY:
PERMITTEE SIGNATURE: 'k i�' �% — ✓�
DATE: 9/29/2004
_Ai. Alit SIGN PERMIT APPLICATION
44
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 A 1 e k 3' _,L 45 a r a r c e
0 b Z76
Address/ Street Address Permit No.: 561 4 2-t) N'
Location /e S_-/ / P,4 /d 5'1
Expiration Date: a /(( 11 / // Sute /Bldg. # City /State Zip
7 7 : " rd� 0 k ey c , t 9;_,2,24 Receipt #:
Name / p� Approved By: -1'I/
c( U /49 c
Property Date: �Z
Owner Mailing Address Suite Map/TL #:
% 'rXo 54/ / 4 4 Zoning:
City/State Zip Phone
. /c)� Electrical Permit Required? El Yes [:go
Tenant or Nam
i
Business /CO. Ym O 1 fa r4 r y e Building Permit Required? ID Yes �No
Name Rev. 7/1/04 is \curpin \masters\revised \sign permit app.doc
Sign
Contractor , ..iling 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/Stat- Zip Phone
licenses are
required if ❑ Completed Application Form
expired in - Oregon Const. Cont. Board xp. Date
City igard's License # E 2 Copies of Site /Plot Plan, Drawn to Scale
abase) (3 copies, if 'a building permit is required)
Proposed 1 Permanent s requirement: 8 x 11", or 11" x 17"
❑ Freestanding ❑ Fre q ,
Sign LI Temporary ❑ Wall ❑ Electronic
(Check all that Other ❑ Billboard ❑ Balloon I=1 2 copies of elevations, drawn to scale
apply) (3 copies, if a building g permit is required)
❑ New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
x Sign Dimensions: ,/Z ❑ $32.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): / x ❑ $15.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) Jurisdiction: 111 City El 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: C-ef---yz-z/ • 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
El 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 ll �!
Signature of Owner /Agent
„Po et /eil /77C7/41 5a) -
Contact Person Name Phone No.
CITY OF TIGARD 9/29/2004
13125 SW Hall Blvd. 2:31:17PM,
�l Tigard, Oregon 97223
(503) 639 -4171
Receipt #: 27200400000000004321
Date: 09/29/2004
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2004 -00276 [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 DONALD L HEMLICK KJP 015881 In Person 15.00
Payment Total: $15.00
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