SGN2010-00015 t r - r
7 1 Community Development
Request for Permit Action
TIGARD
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
(check one)
REFUND OR Name: No fees paid, not applicable.
INVOICE TO: (Business or Individual)
Mailing Address:
City /State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
® CANCEL PERMIT APPLICATION.
n REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
niit #: SGN2010 - 00015
, \ Si e Address or Parcel #: 11634 SW Pacific Hwy.
�° Pro j ect Name: Subway
It 1 15 ��.
I . Subdivision Name: Lot #:
II
EXPLANATION: Applicant decided to change two permanent signs to one temporary sign
. instead. Please void this application.
Signature: 0_,A./.4., Co. Date: 2/25/10
Cheryl Caines
Print Name:
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to egg Admin: Date /0 //d By ./,
Refund Processed: Date ^/ //}— By 1` Invoice Processed: Date By
Permit Canceled: Date $�a/ // 0 By - Parcel Tag Added: Date By
Receipt # Date / / Method Amount $
I:\ Building \Forms \RegPemutAction.doc Rev 07/26/07
{ :�
. —7- $�� SIGN :+ . aid MIT AP? .IC ' TI N
} Ell .,
k '� City of Tigard Permit Center 1375 S1.17 Halll3lvd., Tigard., OR 97223 ....
r
4 M,. to Phone. 503.639.4171 Fax. 503.598.1960 ' , "�' „A.til
GENERAL INFORMATION '
•
Name of Development/Project
,- 1 FOR STAFF USE ONLY S t�:�, .. /
Site � 1(', on-);;.....7. jC.tti „ I
Address/ Sereeu Address ( Permit No.: ._% (_. . 1' .;.2 Ciit;• -- C, r.' ( i
1 ` r
v00
r /'
L ocation ' l t -> ____....
Expiration Date:
Suite /Bldg. # City/State Zip
_
( ! ) �. Receipt #:
Name Approved By:
r
�
,P) Date:
Property � � ■ 1 .'c' �� : %. �� - i - � _ _
Owner Mailing Address Suite Map /TL,#: j,,<,' r �' 1 . f 1,1;� --- (..;,,),s-0 -
1 1 1 . . Li *-1 p r c4,t_ 1%,,,,: Zoning: C� ._ lu
..
City/State Zip Phone
.1 ' , ..1- ':i ��. r - r -- lrf n.
r t ` 7 . a ) Electrical Permit Required? ❑ Yes ❑ No
Tenant or Natne
Business Building.Permit Required? ❑ Yes ❑ No
Name Rev. 7/1 /09
is \curpZ \ masters \land use applications \ sign permit app.doc
Sign
Contractor Mailing Address Suite
(Prior to permit
issuance, a
copy of all City /State Zip Phone REQUIRED SUBMITTAL ELEMENTS
licenses are (Note: applications will not be accepted
required if without the required submittal elements)
expired ie the Oregon Const Cont 13oard License # Exp Date
City of T'igard's
database) ❑ Completed Application Form
Proposed ❑ Permanent ❑ Freestanding ❑ Freeway 2 Copies of Site /Plot Plan, Drawn to Scale
Sign ❑ Temporary ❑ Wall ❑ Electronic (3 copies, if a building permit is requited)
(Check all that ❑ Other ❑ Billboard ❑ Balloon 1 11"
apply) size requirement: 8 /z ' x 11", or 11 x 17"
5 New sign? ❑ Alter to existing sign? I 1 2 copies of elevations, drawn to scale
Sign Dimensions: r r ,-. e
`^ , (3 copies, if a building permit is required)
I h c " - 1 , >, size requirement: 8 x 11 ", to 24" x 36"
Total Sign Area (sq. ft.): t t
i . r $40.00 Fee (Permanent sign, any size)
Total Wall Area (sq. ft.)
Sign Data $19.00 Fee (Temporary sign, any type)
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section)
N S : 'E ,W NE NW SE SW
Height to top of sign (feet): Il 'ct! -,.'7'-- • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): "2 must include dimensions of wall face and sign
l placement.
Copy:
,-- (.q /' 1 /, o Wall signs do not require site /plot plans.
Materials v,q��l - j . ` {, -� ci,' `1 o Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ Yes [ No permit.
Type: ❑ Internal ❑ External o If work authorized under a sign permit has not been
Are there any existing freestanding or wall signs at this location, completed within ninety (90) days after the issuance
including wall signs that overlap a tenant space? of the permit, THE PERMIT WILL BECOME
❑ Yes No NULL AND VOID.
If "yes ", a list or diagram of all sign dimensions and square
footage must also`be submitted.
(OVER FOR SIGNATURES)