SGN2004-00326 CITY OF TIGARD SIGN PERMIT
'" I DEVELOPMENT SERVICES PERMIT #: SGN2004 -00326
c DATE ISSUED: 11/9/2004
a
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110AA 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'X8'
TOTAL SIGN AREA: 18 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION): S
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of (1) one 18 sq ft banner. Valid 11/11/04 thru 12/11/04. Sign #3
MATERIALS: BANNER
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 o sr permit shall- expire. A temporary sign shall expire 30 days from validity
date. A balloon sign shall expire 10 day om v lidity date.
APPROVED BY:
PERMITTEE SIGNATURE:
DATE: 11/9/2004
•
¢+•�_,: 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 akin er.5 ______;7_5arse4c
Address/ Street Address Permit No.: w LodLf _ 4
Location /05 S e- Ay/ u /
Expiration Date: l l I I (' h `C — t L i
( q
Suite /Bldg. # City /State i Zip
/.,.5--- 779a vi , c17mydti Receipt #:
Name Approved By: /K-
Property Date: llh(c. y
Owner Mailing Address Suite Map/TL #:
Zoning: 6"<-7
City /State Zip Phone
_ Electrical Permit Required? ❑ Yes El—No
Tenant or Name
h Gl E , Building Permit Required? El Yes o
�
Business r�r e rS � S r a � f
Name // Rev. 7 /1/04 is \curpin\ masters \revised\sign permit app.doc
Sign
/U le_b �l i s k
Contractor Mailing Addre . rite /o 5- REQUIRED SUBMITTAL ELEMENTS
(Prior to permit 0,5 . ` , °� 41 (Note: applications will not be accepted
issuance, a without the required submittal elements)
copy of all City /State Zip "hone
licenses are
required if / "Y' r ❑ Completed Application Form
expired in the Ore. • Const. Cont. Board Exp. Date
City of Tigard's ' ense # ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
database)
(3 copies, if a building permit is required)
Proposed El Permanent El Freestanding El Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign Temporary ❑ Wall
❑ Electronic El 2 copies of elevations, drawn to scale
(Check all that ❑ Other El Billboard ❑ Balloon
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: 3 X 6' ❑ $32.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): / 8 ❑ $15.00 Fee (Temporary sign, any type)
Si n Data Total Wall Area (sq. ft.) Jurisdiction: ❑ City ❑ Urb
9
(Complete all Direction Wall Faces (circle one): NOTES:
items in this
section) N �) 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 .fir No building permit.
_ Type: El Internal El 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 I
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 AA/e/? b er , 20
4 Z-e/(_
Signature of Owner /Agent
�on / is of -
Contact Person Name Phone No.
S'a v Q 3 0 o roa
•
4 CITY OF TIGARD 11/9/2004
13125 SW Hall Blvd. 9:38:26AM
Tigard, Oregon 97223
„ ' e'' (50 3) 63 9-4 17 1
Receipt #: 27200400000000004874
Date: 11/09/2004
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2004 -00326 [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 HELMICK KJP 001439 In Person 15.00
Payment Total: $15.00
•
cReceipt.rpt Page 1 of 1