SGN2010-00098 I t
IMI SIGN PERMIT APPLICATION
City of Tigard Permit Center 13 125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960
GENERAL INFORMATION
Name of Development /Project
FOR STAFF USE ONLY
Site �T[7� l� _ 11201)b DU _ (-t— �,/
Address/ Street Address Permit No.: � J-0( 0 - (�Lt o R .
Location ('p 77 7 Std &6
Expiration Date:
Suite /Bldg. # City/State Zip
1,)d T/6,426, ve-- q 1 o f Receipt #:
Name Approved By: -
Property
UMLitA e.ze)a-- /30--SCI! (3 Gst_ Date: SI a5 if ()
Owner Mailing Address Suite Map /TL #: 2 5 II a A A WO 0 ' �
t l �l! l S' 1 �� Zoning: (L—
City/State Zip �/ Phone
POk-T[ �t? _ i 9 -)ass &- p_3"��- ;-)-gam Electrical Permit Required? ❑Yes o
Tenant or Name
Business .5.1 ok.0 , td()D Z(T(..(� /
D B Building Permit Required? ❑ Yes No
Name Rev. 7/1/09
e0 LX is \curpin \masters \land use applications \sign permit app.doc
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Sign ) #4 5 A t-1
Contractor Mailing Address p „" .. ) Suite
(Prior to permit
4/74)‘47A471 „ , IaC.t,/,,A
issuance, a r'
copy of all City /State Zip Phone REQUIRED SUBMITTAL ELEMENTS
licenses are (Note: applications will not be accepted
required if fAtiet)U0 ,W A 4' 1 tk6/ ;P0 6qe.. (9 without the required submittal elements)
expired in the Oregon Const. Cont. Board License # Exp. Date
City of Tigard's
database) 1 �f9�c�(VD ❑ Completed Application Form
Proposed 'Permanent ❑ Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale 1
Sign ❑ Temporary E. Wall ❑ Electronic (3 copies, if a building permit is required)
(Check all that ❑ Other ❑ Billboard ❑ Balloon
apply) size requirement: 81/2" x 11 ", or 11" x 17"
New sign? ❑ Alter to existing sign? ❑ 2 copies of elevations, drawn to scale
Sign Dimensions: (3 copies, if a building permit is required)
/8540 . 1 1' . =)-7. 1 size requirement: 8 x 11", to 24" x 36"
Total Sign Area (sq. ft.):
3_C- / ❑ $40.00 Fee (Permanent sign, any size)
Total Wall Area (sq. ft.)
Sign Data g{P41- ❑ $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): e>a(0 ♦ Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): /a, must include dimensions of wall face and sign
placement.
Copy:
• Wall signs do not require site /plot plans.
Materials:
• 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
[/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 , 20
Signature of Owner /Agent
Contact Person Name Phone No.
I 1 2 3 � 4 5 6 I 7 �— 8 � 9 � 10 l l
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-_ ' "TE " "AT' ° " "` Tenant Space = 99.83' (wide) x 26.5' (tall) = 2,645,49
SIGN ASSOCIATION -
15% of 2,645.49 = 396.82 5F (MAX 5F ALLOWED BY GODS)
F r
I a - - 99.83' D
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Pre -wired with 1/4" Riv Nuts, Threaded Rod Letter Height: 16" to 12" (STONE +WOOD OUTLET) �, � S:r
3M Vinyl Graphite - APPLIED TO LETTER FACES LED LOGO BOX 3/16" Acrylic Faces, 1" Trim Cap, Grid Pattern LED'S, 5" Deep .040 Returner 063 White B ck5 Pr�r •IV)ir�it�,�s' w� f � � � I
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,v � ThLs design. manufacturing technique and or Idea is the property of CoNmbW Signs .Inc. PfO�eC[ManageF: COd }t RelCh I COd}
and may not be changed. published. reproduced or used in arty way without the wntten
/'� �.+'/� � permission and (ull consent of Columbia Signs. Inc. In addltbn all designs, bKls. drafts.
.corn contents ofpmposalsandanyspecificatbnscontainedonth4stayoutmaynotbeu�dto ❑ Not Approved Please make the changes as indicated above and resubmit forapprovat
I � I secure price compadsons. Redlstributbn of infortnatbn contained on this form is (ull � I
acknowledgment and apptrnal of the terms and pace listed. Vblators will be prosecuted
4700 Four[h Plain Blvd. Vancouver. WA 9E3661 to the full extent of the law. IF YOU HAVE ANY QUESTIONS. ASKFI RST. ❑ ApprOVed SignatuFe DaCP QCy Of Signs
� Office, Sh0 fflb - 1919 I Fax 560 -696 -9797
R` '�'� - 'm'� CITY OF TIGARD RECEIPT
,�
. � �', 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
�ric'�Rn
Receipt Number: 178062 - 05/25/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2010 -00098 Sign Permit 1003100 -43115 $35.00
SGN2010 -00098 Sign Permit - LRP 1003100 -43117 $5.00
Total: $40.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 04509D STREAT 05/25/2010 $40.00
Payor: Cody Reich
Total Payments: $40.00
Balance Due: $0.00
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