SGN2002-00275 CITY OF TIGARD SIGN PERMIT
• I DEVELOPMENT SERVICES PERMIT #: SGN2002 -00275
A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/13/02
PARCEL: 2S 102AC - 01704
BUSINESS NAME: TIGARD DENTAL ZONE: CBD
SIGN LOCATION: 12720 SW PACIFIC HWY JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: FREEWAY:
TEMPORARY: X WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 8' X 2'
TOTAL SIGN AREA: 16 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION): SW
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of (1) one temporary banner. Valid 12/13/02 thru 1/12/03.
MATERIALS: VINYL
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 e op 0 days from validity date.
APPROVED BY: -
PERMITTEE SIGNATURE: On—
DATE: 12/13/02
12/05/2002 15:33 FAX 5036847297 City of Tigard ll002 /005
A,, . CEIVED
a�,: ,1,�,r P P L I CAT I O
�,,� SIGN PERMIT R M I T A
CITY OF TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684-7297 DEC 0 9 2002
CITY OF TIGARD
GENERAL INFORMATION Rt1ILDING DIVISION
Name of Development/Project FOR STAFF USE ONLY
Site T i & Pi eD DEN - A i- 1 M 3
-
Address!
Street Address Permit No.: $ 7 /✓ Z- 7_ — ebb 2 75
Location 12120 S Tin& PACIFIC Nw y Expiration Date:
Suite /Bldg. it City /State Zip
2 T / CTF g72ZS Receipt #: T T
`/
Name Approved By
•
Property QTU R w l IG i - OQ 1 Dpi _ Date: 1 - 13 Zr •
Owner Mailing Address Suite Map /TL #: o2 AC J 0/7 DI'
12,72,o S U PSG t F (C NUS Z Z oning: _ /
- City /State Zip Phone
r A D� (47213 (C63)6g11" qo1 E lectrical Permit Required % ❑ Yes p No
Tenant or Name
Business Ti G14 i wN' AL IM Pt( sC.S Building Permit Required? ❑ Yes ® No
Name Rev. 01- Jul -02 i:1curpin \masters \revised\sign permit app.doc
1
Sign
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuance, a
copy of all City /State Zip Phone without the required submittal elements)
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 ill Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign ® Temporary N Wall ❑ Electronic
(Check all that ❑ Other Billboard ❑ Balloon ❑ 2 copies of elevations, drawn to scale
apply) (3 copies, if a building permit is required)
Et ❑ New sign? EJ Alter to existing sign? size requirement: 8 x 11 ", to 24" x 36"
Sign Dimensions:
p x z, ❑ $30.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): 16 t7' $15.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.)
9
(Complete all Direction Wall Faces (circle one): NOTES:
items in this
section) NS E W NE NW SE
D • 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: ✓ I N' L • 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 L
square footage must also be submitted.
(OVER FOR SIGNATURES)
12/05/2002 15:34 FAX 5036847297 City of Tigard 2003/005
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 }h day of Deceen be4 , 20 O2
4 2) , A2 - IP ' 11)12
Signature of Owner /Agent
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Contact Person Name ` Phone No.
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12720 SW Pacific Hwy. #2. • Tigard, OR 97223 • (503) 684 -9017
CITY OF TIGARD 12/13/2002
13125 SW Hall Blvd. 12:44:14PM
!Mt, Tigard, Oregon 97223
,44-11., (503) 63 9-4 17 1
Receipt #: 27200200000000004745
Date: 12/13/2002
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2002 - 00275 [SIGN] Temp Sign Perm 100- 0000 - 437000 15.00
Line Item Total: $15.00
Payments:
Method Payer User ID Acct. /Check Approval No. How Received Amount Paid
Check TIGARD DENTAL KJP 123 In Person 15.00
Payment Total: $15.00