SGN2002-00236 CITY TIGARD SIGN PERMIT
z*ote Ise I DEVELOPMENT SERVICES PERMIT #: SGN2002 -00236
DATE ISSUED: 11/4/2002
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
EXPIRATION DATE:
BUSINESS NAME: TIGARD DENTAL IMAGES PARCEL: 2S102AC -01704
SIGN LOCATION: 12720 SW PACIFIC HWY
APPLICANT /AGENT: ZONE:
BUSINESS TAX NO: JURISDICTION:
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 4X2
TOTAL SIGN AREA: 8 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION): W
SIGN HEIGHT: 8 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: 1 permanent wall sign
MATERIALS: WOOD
EXISTING SIGNS: 2
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 30.00
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 10 days from validity date.
APPROVED BY: / ' " t /
PERMITTEE SIGNATURE: "C `'"
DATE: 11/4/2002
CITY OF TIGARD 11/4/2002
13125 SW Hall Blvd. 2:47:27PM
"YI A Tigard, Oregon 9 72 23
Ili (503) 639 -4171
Receipt #: 27200200000000004209
Date: 11/04/2002
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2002 -00235 [SIGN] Temp Sign Perm 100 - 0000 - 437000 15.00
SGN2002 -00236 [SIGN] Sign Permit 100- 0000 - 437000 30.00
Line Item Total: $45.00
Payments:
Method Payer User ID Check No. Approval No. How Received Amount Paid
CreditCard MARIA WIKTOR MET 803716 In Person 45.00
Payment Total: $45.00
: . . , ; ti:lt
I: SIGN PERMIT APPLICATION
CITY OF TIGARD 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 TI&Prg DGNF AL IMAUES
Address/ Street Address Permit No.: 564,77.07Z- _ 00?-36
Location 12:n0 Si,.( P F IL H Uy Expiration Date: ./
Suite /Bldg. # City /State Zip
1 T1 &ar�D I Dk 9722 Receipt #:
Name Approved By: -74�
Property F Q I U IZ LI I V i OR Date: (/ f O
Owner Mailing Address , . Suite Map /TL #:
1212,0 SL.i PACIF(cdo. It 2 Zoning: L &
City /State Zip Phone
TIC7K.D OQ q`1.223 (596g9-q017 Electrical Permit Required? ❑ Yes iNo
Tenant or Name
Business 'TI & ED D6N 17 1- I M A G %,S Building Permit Required? ❑ Yes o
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 ❑ Temporary ❑ Wall ❑ Electronic
(Check all that ❑ Other ❑ B ❑ Balloon ❑ 2 copies of elevations, drawn to scale
apply) (3 copies, if a building permit is required)
❑ New sign? ❑ Alter to existing sign? size requirement: 81/2" x 11 ", to 24" x 36"
Sign Dimensions: I , sz
u $30.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): 8 ❑ $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 0 NE NW SE SW • Wall signs do not need to be drawn to scale,
Height to top of sign (feet): but must include dimensions of wall face and
Projection From Wall (inches): sign placement.
Copy: • Wall signs do not require site /plot plans.
Materials: • Freestanding signs over 6 ft. required a
building permit.
Will sign have illumination? ❑ Yes ❑ No • 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)
r
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 i-t tiv day of TJO VE N1 !ic. , 20 02,
Signature of Owner /Agent
/1 (i —
Mpt,i,„ i,,,,o, 503 66�I -gel
Contact Person Name o n No
i _ _ _ _ _ _ _ ___ _. _ _ ____ ___ _ _ I .
T I &A tD
�,{ I N,70U iki 1, INA - 665 Llf N OO V
I. ' 7 -J ( A 4TuR 41 t ore �
`ill � CO3 68
i i _
i
301'