SGN2003-00073 CITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2003 -00073
X1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/7/03
PARCEL: 2S 102AA -05500
BUSINESS NAME: HOUSE TERIYAKY EXPRESS ZONE: CBD
SIGN LOCATION: 12215 SW MAIN ST JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: Y FREEWAY:
TEMPORARY: X WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3'X4'
TOTAL SIGN AREA: 12 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: 4 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of (1) one temporary A -frame sign. Sign to be placed on private
property and not in the public right -of -way. Valid 7/2/03 - 8/2/03. Sign #3
MATERIALS: WOOD
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 15.00
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 0 a from validity date.
APPROVED BY: -
PERMITTEE SIGNATURE: 6 '�'� "` -)
DATE: 4/7/03
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�e,i� SIGN PERMIT APPLICATION
CITY FT I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name of Development/Project FOR STAFF USE ONLY
Site -6061 T I� 4V "tKfr. �
Address/ Street Address Permit No.: 5 yt/z 36Ob7
Location 1 2- 2 (S SW MOt' n- 9 Expiration Date: 7/210 3 8/2/o3
Suite /Bldg. # City /State Zip a...00-3 - �,
l I v 'TI UA K l) Receipt #: { / �
Name Approved By: t
Property 5 Z.. 4•A — �S vU
tq ) I� J v Date: e/(3
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Owner Mailing Address Suite Map /TL #:
'12_2—) c , IX) Mat,fr, t I 0 Zoning:. C 3-D
City /State Zip Phone
2 Q�
Ti rM' dI ��2ZZj ST /5 6 �" Electrical Permit Required? ❑Yes pK] No
Tenant I I Building Permit Required? ❑ Yes No
Business s N ame Ct USA 'r 00 � .X�
Name Rev. 01 -Jul -02 is \curpin \masters \revised \sign permit app.doc
Sign
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuance, a • without the required submittal elements)
copy of all City /State Zip Phone
licenses are
required if ❑ Completed Application Form
expired in the Oregon Const. Cont. Board Exp. Date
City of Tigard's License # ❑ 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 132 Temporary ❑ Wall ❑ Electronic •
(Check all that ❑ Other ❑ Billboard ❑ Balloon El copies of elevations, drawn to scale
apply) (3 copies, if a building permit is required)
❑ New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions: ! ` r
_ ❑ $30.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): / �-- ❑ $15.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.)
(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,
Height to top of sign (feet): L f but must include dimensions of wall face and
Projection From Wall (inches): sign placement.
Copy: o Wall signs do not require site /plot plans.
Materials: o Freestanding signs over 6 ft. required a
building permit.
Will sign have illumination? ❑ Yes ❑ No o If work authorized under a sign permit has not
Type: ❑ Internal ❑ External been completed within ninety (90) days after
Are there any existing freestanding or wall signs at this the issuance of the permit, THE PERMIT WILL
location, including wall signs that overlap a tenant space? 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)
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 5 2_ - day of , 20
A A/
Signature if owner /Agent
Contact Person Name Phone No.
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CITY OF TIGARD 4/3/2003
13125 SW Hall Blvd. 10:46:27AM
/lMi,\ Tigard, Oregon 97223
AilL 6 1 (503) 63 9-4 17 1
Receipt #: 27200300000000001309
Date: 04/03/2003
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2003 -00066 [SIGN] Temp Sign Perm 100- 0000 - 437000 15.00
SGN2003 -00068 [SIGN] Temp Sign Perm 100 -0000- 437000 15.00
SGN2003 -00073 [SIGN] Temp Sign Perm 100 -0000- 437000 15.00
Line Item Total: $45.00
Payments:
Method Payer User ID Acct. /Check Approval No. How Received Amount Paid
Check PHUONG NGUYEN KJP . 664 In Person 45.00
Payment Total: $45.00