SGN2010-00037 nirOVVAVNE
. rah. , .
i; °e SIGN PE 1'Z y l ii IT AP ?L CATI ON
0 �� �, Cif) of Tigard. Permit Center 13125 SW .1 -fall Blvd., Tigard, OR 97223
S Phone. 503.639.4979 Fax: 503.598.1960
GENERAL INFORMATION
Name of Development /Project
boo-- FOR STAFF USE ONLY
Site �I�-
Address/ Street Ad ress 1 Permit No.: ) �DI(� — 0&03 7
Location ID (p c ) /21A) CAJ [A,
Expiration Date:
Suite /Bldg. # City /State Zip
Receipt #: 1") ( D.-1
Name I > tlpproved By:
- (Q &A l •
Property 1 C ) - 1 -J Date: 3 /(-/ f Q /�
Owner Mailing Address Suite Map/TL 0 S 10 3A A 0 U ( 0
2-
Zoning: S
C!r /State Zip Phone
Electrical Permit Required? ❑ Yes
Tenant or Na,nc".„^. f / i y
Business ' j 611 ' C'. \! all �l T L 1 , i ;� Building Permit Requited? El Yes No
1 " "
Name 'J Rev 7/1/09
is \curpin \masters \land use applications \sign permit app.doc
Sign A ifiV
Contractor Mailing Address Suite
(Prior to permit
issuance, a
copy of all City/State Zip Phone REQUIRED SUBMITTAL ELEMENTS
Licenses are (Note: applications will not be accepted
required if without the required submittal elements)
expired in the Oregon Const. Cont. Board License # Exp. Date
City of Tigard's
database) ❑ Completed Application Form
Proposed jll. Permanent ❑ Freestanding ❑ freeway 2 Copies of Site /Plot: Plan, Drawn to Scale
sign h1 Temporary ❑ Wall ❑ Electronic (3 copies, if a building permit is requited)
(Check an that ❑ Other ❑ Billboard ❑ Balloon "
apply) size requirement: 81/2" x 11' , or 11" x 17"
'f New sign? ❑ Alter to existing sign? 1 1 2 copies of elevations, drawn to scale
Sign Dimensions: (3 copies, if a building permit is required)
x' size requirement: 8 x 11 ", to 24" x 36"
• Total Sign Area (sq. ft.): + e.
f 16f- ( 't 1 1 $40.00 Fee (Permanent sign, any size)
Total Wall Area (sq. ft.) V
Sign Data 1 1 $19.00 Fee (Temporary sign, any type)
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S E W NE NW SE SW
1 - Ieight to top of sign (feet): tp+ o Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): J must include dimensions of wall face and sign
placement.
Copy: o Wall signs do not require site /plot plans.
Materials: o Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ Yes . No permit.
Type.: ❑ Internal ❑ Exterr!al o If work authorized under a sign permit has not been
Are there any existing freestanding or wall signs at this location, completed within ninety (90) days after the issuance
including wall signs that overlap a tenant space? of the permit, THE PERMIT WILL BECOME
❑ Yes El No 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 f am
the owner or authorized agent of the owner, and that plans submitted are in compliance with the City
of Tigard.
r
DATED this . J day of lr�,� �,��� L. 1 'o '
If Signature of Owne/Agea`'
r :
C r1 CA, di _ I �� 1-79 -7,JD , 1/
Con Person Na e Phon.e No.
� C- '� f boffa6c1U g (1n
1 . n 1 ,
14---0 •
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
• •
Receipt Number: 177121 - 03/05/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2010 -00037 Temp Sign Perm 1003100 -43115 $17.00
SGN2010 -00037 Temp Sign Perm - LRP 1003100-43117 $2.00
Total: $19.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 5397 KPEERMAN 03/05/2010 $19.00
Payor: Nancy Barlow
Total Payments: $19.00
Balance Due: $0.00
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