SGN2004-00364 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 30 day of ,ddt/ , 20 0
S'0 atufe of,O ner •gent
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Contact Person Name P one No.
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