SGN2002-00194 : 4p ; CITY OF TIGARD SIGN PERMIT
i, DEVELOPMENT SERVICES PERMIT #: SGN2002 -00194
+ � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/16/02
EXPIRATION DATE:
BUSINESS NAME: HOUSE TERIYAKY EXPRESS PARCEL: 2S102AA 05500
SIGN LOCATION: 12215 SW MAIN ST 110
APPLICANT/AGENT: ZONE:
BUSINESS TAX NO: JURISDICTION:
SIGN
PERMANENT: FREESTANDING: Y FREEWAY:
TEMPORARY: X WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 4'X3'
TOTAL SIGN AREA: 12 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: 4 ft.
PROJECTION FROM WALL: in.
ILLUMINATION:
DESCRIPTION OF SIGN: Placement of (1) one 4'x3' temporary A -frame sign. Sign shall be placed on private
property and not in the public right -of -way. Sign valid 10 -22 -02 - 11- 21 -02.
Sign #1
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 da or . gn permit shall expire. A temporary sign shall expire 30 days from
validity date. A balloon sign shall expire 0 s from validity date.
APPROVED BY:
PERMITTEE SIGNATURE:
DATE: 10/16/02 '
11 ,
,� ., 2. SIGN PERMIT APPLICATION
CITY F 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 C' c
Site 1 6U-< Te/rt �/ 'Z� -efr&9 �� /11 2� 2 - Cad I T
Address/ Street Address ✓ Permit No.: /
Location /—Z /S ,.5k.) ,44' .n �fi ee , - Expiration Date: /o(-ZJ °2 — (I 12,/ (
Suite /Bldg. # City /State Zip
I I b 7 6K 972Z3 Receipt #: L. ' 3 i
Name Approved By: / /
Property Tim rri Date: 1 1/2 4 10 L
Owner Mailing Address Suite Map/TL#: Z 5 /0z, /4 -0.5
2-2_ /.S $c) /'4 n 3 Zoning: C /3 0
City/State Zip Phone
/
�ia/vvel 04 e l l 5 Electrical Permit Required? ❑ Yes p- No
Tenant or Na4+fe y re, rG Building Permit Required? El Yes a No
Business fTO[ce, � t�.c�,
Name OO 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 i' /s �w /I!/�cn s'f9 e without the required submittal elements)
copy of all City /State Zip Phone
licenses are �4Lq - Gs
if 7? a'L T [ Completed Application Form
expired in the /egon 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 ❑ Billboard ❑ Balloon L� 2 copies of elevations, drawn to scale
apply) (3 copies, if a building permit is required)
EC New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions:
if )<3 ' g $30.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): r Z 56)F $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): 1 / but must include dimensions of wall face and
Projection From Wall (inches): sign placement.
Copy: • Wall signs do not require site /plot plans.
Materials: /A)490c/ I • Freestanding signs over 6 ft. required a
building permit.
Will sign have illumination? ❑ Yes 0 No • If work authorized under a sign permit has not
Type: 1=1 Internal External been completed within ninety (90) days after
Are there any existing freestanding or wall si at this the issuance of the permit, THE PERMIT WILL
location, including wall signs that overlap a tenant space? BECOME NULL AND VOID.
❑ Yes X 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 day of b / , 20
Signature if Owner /A. - •
L I S A ) 64,1
Contact Person Name Phone No.
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10/16/2002
11 :07AM
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T I D E M A R K
COMPUTER SYSTEMS. INC.
Receipt #: 27200200000000003943
Date: 10/16/2002
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2002 -00194 [SIGN] Temp Sign Perm 100 - 0000 - 437000 15.00
Line Item Total: $15.00
Payments:
Method Payer Bank No Account No Confirm No How Received Amount Paid
Check PHUONG NGUYEN KJP 535 In Person 15.00
Payment Total: $15.00