SGN1997-00155 SIGN PERMIT APPLICATION
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13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
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CITY OF TIGARD
GENERAL INFORMATION (PLEASE PRINT CLEARLY}
Sign Address /Location: 13 / 6 C 5'w PA.c; Z'e- ti
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Name of o Tenant/Business: t/Bu '
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? , ®, Date`: Received < : > :::...... <;.:.:;..::; ::: :. >: ::r
Addresse (6S St PHc:ii( 146.. / / �► . E p 2 .. .
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Applicant/Agent/Contact Person: eceived By: . =
r Permit Nos > I :: :�J:: >' .. -. : : :. ,., ..
Sign Company: Str£, nl S S Al Phone: �S ai� `T 3a 'o , ; , '''' , ' , ;g%'> % < :< :> <> : :<:::. <... , ; ; <;GI :: ><;.::..
Permit > ::; := >:< .' : : ;:.::,:::'• : s' ... : :;
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Address: 39 �/� Gr2c7w n! P t o• 'n, Hi.) ee . v
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city: C �R B,�TT ::
tY S tate: 04 z ip: 9 7 Qo
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C.C.B. #: / > Date of<Ap rova ;> ::.:: :. : :
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p ton Date. •— � �?: >:..;: <:;' >` .
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Expiration
City of Tigard Business Tax #:
(or) Expiration Date: Zoning: ......,
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Business s Li
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ectrical.,.Permit. Regwred . ,Y , :;'< No --0
Proposed sed '
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(check c as many an
P Sign: ( y applicable) Idmg Permit Requi <Yes: >: : No
Permanent an n
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Freestanding tandin
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Temporary ❑ Wall ;,:.:..: -
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Other ❑ Billboard ❑ Balloon ❑
Sign Dimensions: /4 . < / 4/ ' / �'
Total Sign Areas (sq. ft.): o l d . / 7
is 4k ¢ REQUIRED SUBMITTAL ELEMENTS
Total Wall Area (sq. ft.): (0 6 Sq I"
Direction Wall Faces: (circle one) N ( E W NE NW SE SW ❑ Completed Application Form
Height (ft.): /`i3 >< � '7 ❑ Site /Plot Plan Drawn to Scal
Projection from Wall: ..) (2 copies, 3 if a building permit is required)
Illumination: Yes ® No ❑ Type: Internal 1R External ❑ ❑ Elevations Drawn to Scale
(2 copies, 3 i f a building permit i s requ
U.L. Label #:
❑ Applicant's Statement
Copy: goegr2r l' ❑ Fee (Permanent Sign, any size) $50.00
Materials: 80o N 7_E �►¢G�G,,,at, e, /,'L n1fo� ❑ Fee (Temporary Sign) $15.00 a. i
Are there any Existing Signs at this Location? Yes (;_l No
[f yea, a Ilst of all sign dimensions must also be submlttadJ I certify that I am the recorded owner of the
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° �,� �i e de prop rtY or an agent authorized by the owner.
NOTE: 4 If work authorized under a sign permit has not been J
completed within ninety days after the issuance of the tki
permit. THE PERMIT SHALL BECOME NULL AND VOID. Applicant's Signature
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List any VARIANCE OR OTHER LAND USE ACTIONS to be considered as part of this application:
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APPLICANTS:
To consider an application complete, you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as
described on the front of this application in the "Required Submittal Elements" box.
(Detailed Submittal Requirement Information sheets can be obtained, upon request, for all types of Land Use Applications.)
THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any deed restrictions that may be attached to or imposed upon the subject
property,
• If the application is granted, the applicant will exercise the rights granted in accordance with the terms and subject to all
the conditions and limitations of the approval.
• All of the above statements and the statements in the plot plan, attachments, and exhibits transmitted herewith, are true;
and the applicants so acknowledge that any permit issued, based on this application, may be revoked if it is found that
any such statements are false.
• The applicant has read the entire contents of the application, including . `the policies and criteria, and understands the
requirements for approving or denying the application.
SIGNATURES of each, owner of the subject property.
DATED this day of . 19
Owner's Signature Owner's Signature
Owner's Signature Owner's Signature
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