SGN2001-00183 CITY OF TIGARD SIGN PERMIT
P DEVELOPMENT SERVICES DATES U 0/8/2001 N2001-00183
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
EXPIRATION DATE:
BUSINESS NAME: DENTAL DYNAMIC PARCEL: 2S110A6 -00201
SIGN LOCATION: 14465 SW PACIFIC HWY
APPLICANT /AGENT: DENTAL DYNAMICS ZONE: C -G
BUSINESS TAX NO: JURISDICTION: TIG
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3' X 10'
TOTAL SIGN AREA: 30 sq. ft.
WALL AREA: 312 sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: 4 ft.
PROJECTION FROM WALL: 11 in.
ILLUMINATION: INT
DESCRIPTION OF SIGN: Permanent placement of (1) illuminated wall sign.
MATERIALS: PLEXI
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: Y
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 50.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All 4 'II be done in accordance with approved plans. A sign permit shall expire 90
days from approval date. A tem • ora • -ign shall expir: days from approval date. A balloon sign shall expire 10
days fmm annrnval data
APPROVED BY:
PERMITTEE SIGNATU -
DATE: 10/8/2001
�,�, -Y,,,w 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 I
FOR STAFF USE ONLY
Site DPm Dyiv tvi G li c ,
Address/ Street Address ,! 1 , Permit No.: c� C�IU ono l - 00 tc6
Location Rams 7 -eei c y 1 1 \ `' il f f
Expiration Date: l`
Suite /Bldg. # City/State Zip
T � q a 9'9.22)4 R eceipt # • V O "
q
Name j `1 Approved By: ( V
Property Mo . 4 0 . /9- P P. Date:
Owner Mailing Address Suite Map/TL #: (9- I I • ' ' Ca();)
);)
/ y'6r5w pa C Zoning: C, -- A-
City/State Zip Phone
1 / 02 f9)-vi Electrical Permit Required? E Yes ❑ No
Tenant or Na
Business MCA f4keA U . /✓1 / Building Permit Required? ❑ Yes ❑ No
Name n Rev. 30 -Jul -01 is \curpin\masters\revised\sign permit app.doc
Sign k) 6Vvtel 'A • �l'A
Contractor Mailing Addr s • Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit /401,4 � (Note: applications will not be accepted
issuance, a
copy of all City/State Zip Phone without the required submittal elements)
licenses are ���
required if PDPik op. q')> p!Completed Application Form
expired in the Oregon Const. Cont. Board Exp. Date
City of Tigard's License # � p 2 Copies of Site /Plot Plan, Drawn to Scale
database) / )-O"y9 a -3-2-t-02-- (3 copies, if a building permit is required)
Proposed size requirement: 8 x 11 ", or 11" x 17"
Pro
p Permanent ❑ Freestanding ❑ Freeway
Sign ❑ Temporary all ❑ Electronic ❑ 2 copies of elevations, drawn to scale
(Check all that ❑ (3 copies, if a building permit is required)
apply) Other ❑ Billboard ❑ B a ll oon size requirement: 81/2" x 11 ", to 24" x 36"
[New sign? ❑ Alter to existing sign? e $50.00 Fee (Permanent sign, any size)
Sign Dimensions:
3f g lo-f( (ah: ❑ $15.00 Fee (Temporary sign, any type)
. Total Sign Area (sq. ft.): 3 S_
NOTES:
Sign Data Total Wall Area (sq. ft.) 3I S ,� • Wall signs do not need to be drawn to scale,
but must include dimensions of wall face and
(Complete all Direction Wall Faces (circle one): sign placement.
items this • Wall signs do not require site /plot plans.
section) N S E f � NE NW SE SW
• Freestanding signs over 6 ft. required a
Height to top o sign (feet): Cf-rf a building permit.
Projection From Wall (inches): /t • If work authorized under a sign permit has not
Copy: , been completed within ninety (90) days after
Materials 021-42.-Q- ���DW the issuance of the permit, THE PERMIT WILL
Will sign have urination? U PI _— BECOME NULL AND VOID.
it
Type: Mil Internal ! -�
Are there any existing freestanding or wall signs at this No all jurisdictions accept credit cards, please call jurisdiction for more information .
location, including wall signs that overlap a tenant space? visa MasterCard
Credit card number / /
❑ Yes ❑ No Expires
If "yes", a list or diagram of all sign dimensions and Name of cardholder as shown on credit card
square footage must also be submitted. $
Cardholder signature Amount
(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 , 20
Signature of Owner /Agent
Contact Person Name Phone No.
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Approved - I
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PERMIT NO.
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Receipt #: 2720010000
. 0000 004027 - '
Date. 10/08/2001 • p s ;AA
T I D E. M R K
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COMPUTER SYSTEMS, INC. •
Line Items:
Case 'No Tran Code Description Revenue Account No „Amount Due
SGN2001 -00183 • [SIGN] Sign Permit 100- 0000 - 437000
., $50:00
•
Payments:
Method Payer Bank No Acct Check No Confirm No Amount. Paid
Check AD_WIN_SIGN . _ 0 1038 ` 0 $50.00
TOTAL AMOUNT PAID: $50.00
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