SGN2010-00109 •
CITY OF TIGARD SIGN PERMIT
Permit #: SGN2010 -00109
COMMUNITY DEVELOPMENT Date Issued: 06/15/2010
11G4KD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S110DCO2300
Jurisdiction: Tigard
Name of Business: Blissful Energy Yoga
Business Address: 11515 SW DURHAM RD E -7
Applicant/Agent: Blissful Energy Yoga,
Work Description: Placement of one (1) temporary sign (A- Board) 2.5 X 3.5 Valid 6/15/10 - 7/15/10 Must
be placed on private property, not in public right of way. Must meet visual clearance
area requirements Sign #1
Permanent: No Freestanding: No Freeway: No
Temporary: 1 Wall: No Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: Yes'
Sign Dimensions: 2.5 X 3.5
Total Sign Area: 8
Wall Area:
Wall Face (Direction):
Sign Height: 3 ft.
Projection From Wall: in.
Illumination: No Illumination
Materials: Wood
Electrical Permit Required: No
Building Permit Required: No
Total Permit Fee: $19.00
Conditions:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable law. 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 validity date.
Approved By: /
Permittee Signature: x _
q SIGN PERMIT APPLICATION
/ City of Tigard Permit Center 13125 SW Hall Blvd, Tigard OR 97223
'47i1, ' is Phone: 503.639.4171 Fax. 503.598.1960
GENERAL INFORMATION
Name of Development /Project
FOR STAFF USE ONLY
Site • 6 \ t Sf 1.)1 C, /Vt 1090.. cc
Address/ Street Address Permit No.: J ? (.-f 1. O - O 0 f
S Location I i � S5VJ �G Q YL,avv , `_� Expiration Date: 6 1t h 3 v " -11
Suite /Bldg. # City/State Zip _�
E- �∎(Ao- ra, -o'� c ` Receipt #: 1�
Name Approved By: K' 3 P
Property
Date: (0/15-if
Owner Mailing Address Suite M /TL#
Zoning:
City/State Zip Phone
Tenant or Name Electrical Permit Required? El Yes [(No
Business 6// ssla 610" YO9k, Building Permit Required? ❑ Yes [3No
Name Rev. 7/1/09
is \curpin \ masters \land use applications \sign permit app.doc
Sign
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 ❑ Permanent El Freestanding El Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
Sign R. Temporary ❑ Wall ❑ Electronic (3 copies, if a building permit is required)
(Check all that
Other ❑ Billboard ❑ Balloon size requirement: 81/2" x 11", or 11" x 17"
apply)
❑ New sign? ❑ Alter to existing sign? ❑ 2 copies of elevations, drawn to scale
Sign Dimensions: (3 copies, if a building permit is required)
LS X 3' s size requirement: 81/2" x11" , to 24" x 36"
Total Sign Area (sq. ft.):
❑ $40.00 Fee (Permanent sign, any size)
Sign Data Total Wall Area (sq. ft.) El $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
Height to top of sign (feet): ♦ Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): must include dimensions of wall face and sign
placement.
Copy:
• Wall signs do not require site /plot plans.
Materials: td Doc/
• Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ Yes ❑ No permit.
Type: ❑ Internal ❑ External • 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
I=1 Yes ❑ 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 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 `1 IN , 20
L41.AN //
Signatur 1 of Owner /Ag -
Contact IVrson Name Phone No.
.x_.: C ITY OF TIGARD RECEIPT
� t 13125 SW Hall Blvd Tigard OR 97223
, 0 503.639.4171
r1GARD;
Receipt Number: 178305 - 06/15/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2010 -00109 Temp Sign Perm 1003100 -43115 $17.00
SGN2010 -00109 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 1374 KPEERMAN 06/15/2010 $19.00
Payor: Blissful Energy LLC
Total Payments: $19.00
Balance Due: $0.00
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