SGN2004-00282 C ITY OF TIGARD SIGN PERMIT
I r
; DEVELOPMENT SERVICES PERMIT #: SGN2004 -00282
!+1- „�: �- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/4/2004
PARCEL: 2S102CB -03101
BUSINESS NAME: TIGARD NATUROPATHIC MEDICINE & CHIROPRACTIC ZONE: C -G
SIGN LOCATION: 12950 SW PACIFIC HWY 115 JURISDICTION: TIG
APPLICANT /AGENT: TIGARD NATUROPATHIC MEDICINE & CHIR
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: FREEWAY:
TEMPORARY: X WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 4' X 32”
TOTAL SIGN AREA: 11 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: 4 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of one temporary A -frame sign. (4' x 32 ") Sign #1. Valid from 10/5/04
through 11/4/04.
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 alidity date.
APPROVED BY:
PERMITTEE SIGNATURE: / ,
DATE: 10/4/2004
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"�,arV 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 e rec . bۥ ), c. FOR STAFF USE ONLY
Site e.., e/ Oki" o ,, A-a c -/mac
Address/ Street Address ,, No.: ,cGISJ B OO- — 0 2)
Location l L93 0 %/'t.� /tea- c1ds'c- h ' y
Expiration Date:
( y /Bldg. # City /State Zip
//J 7 12Z2.-3 Receipt #: ,.Oo4- — `#
Name Approved By: C . Ccu ,-,
Property Ala A //`1)' 11A.. ' Date: 10 -5 - v `1
Owner Mailing Address Suite Map/TL #: .Q5 l via — 0310 1
J/ 7 ✓c, )., -777 Zoning: - " G
City /State Zip Phone
7-yk9a, ✓ / G?Q 9?2L3 Electrical Permit Required? ❑ Yes 0 No
Tenant or N ame Building Permit Required? DI Yes No
Business .1,c /, re-L-4 `�t, .t/ D , 1SG
Rev. 7/1/04 is \curpin\masters\revised\sign permit app.doc
Name / " '/ / /�
Sign 2,4) /"a. / A J1 c �r-J We /2
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit / / ,J - I ,,) Atj+,,,,1,, 4. 'eke . y 00 (Note: applications will not be accepted
issuance, a without the required submittal elements)
copy of all City /State Zip Phone
licenses are Viz -7 0 1, l 0 _ 21 U
required if %C j�' L C Completed Application Form
expired in the Oregon Const. Cont. Board Exp. Date
City of Tigard's License # [a 2 Copies of Site /Plot Plan, Drawn to Scale
database) (3 copies, if a building permit is required)
Proposed ❑ Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11", or 11" x 17"
Sign M Temporary ❑ Wall ❑ Electronic
(Check all that Other IZ 2 copies of elevations, drawn to scale
apply) ❑ Billboard ❑ B alloon (3 copies, if a building permit is required)
El New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions: 9 to ,, >`f x (yZ ',� ❑ $32.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): to, y it . L 12/ $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
Wall signs do not need to be drawn to scale, 1
Height to top of sign (feet): y ' but must include dimensions of wall face and
Projection From Wall (inches): .v/ii sign placement.
Copy: ♦ Wall signs do not require site /plot plans.
Materials: / 0 /n, i ,, nd i ♦ Freestanding signs over 6 ft. required a I
Will sign have illumination? ❑ Yes al No building permit.
If work authorized under a sign permit has not I
Type: ❑Internal E External I
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
BECOME NULL AND VOID.
❑ Yes ❑ No
If "yes ", a list or diagram of all sign dimensions and
square footage must also be submitted.
(OVER FOR SIGNATURES)
• 1
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
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Contact Person Name Phone No.
CS/ CCS/ Cjzzr � 4 -- - / 9
NATUROPATHIC MEDICINE 31" X 47" A -FRAME
Not to scale *A4
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SIGN COMPANY:
SITE ADDRESS: EIN: 01- 0658365
- rtialiit04.16.041.0 ,
12950 SW Pacific Hwy
Tigard, Or 97223
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Approved Ci ' OF TIGARD [ si, nworld
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Fa cnh,, the work as described in: " ;�' 1 `;2 ^"
PERMI1 NO. SP�t\ OO' — l�l) a Pic7�
See Letter to Follow [ ) _'
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CITY OF TIGARD 10/4/2004
13125 SW Hall Blvd. 1:56:55PM
itadoi �i� Tigard, Oregon 97223 •
.r __:.. (503) 639 -4171
Receipt #: 27200400000000004379
Date: 10/04/2004
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2004 -00282 [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 KIM L SCHMALTZ CAC 004009 In Person 15.00
NATUROPATHIC MEDICINE
Payment Total: $15.00
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