SGN2001-00058 i
CITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT#: SGN2001-00058
h4 a
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 04/02/2001
EXPIRATION DATE:
BUSINESS NAME: NELSEN'S TIRE &AUTO PARCEL: 2S103DD-0120
SIGN LOCATION: 13880 SW PACIFIC HWY
APPLICANT/AGENT: NELSEN'S TIRE &AUTO ZONE: C-G
BUSINESS TAX NO: JURISDICTION: TIG
SIGN
PERMANENT: FREESTANDING: Y FREEWAY:
TEMPORARY: X WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3'X4'
TOTAL SIGN AREA: 12 sq.ft.
WALL AREA: sq.ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of Temporary 3'x4'A-frame sign. Not to be placed in visual clearance
area or public right-of-way. Valid 4/4/01-5/4/01. Sign permit#1
MATERIALS:
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 OR. Specialty Codes
and all other applicable laws. All r will be done in accordance with approved plans. A sign permit shall expire 90
days from approval date. Ate porary sign shall expir 0 days from approval date. A balloon sign shall expire 10
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APPROVED BY.� . � C
PERMITTEE SIGNATURE:
DATE: 04/02/2001
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SIGN PERMIT APPLICATION
13125 SW Hall Blvd., Tlgard, OR 97223(503) 639-4171 FAX(503) 684-7297
CITY OF TIOARD
GENERAL INFORMATION (PHASE PRINT MAIM
Sign Address/Location:
FOR STAFF USE ONLY
Name of Tenant/Business: AAEKSFiV rS T 4,r %C)
Address: 13 FF6. s�Jt'.tJ bate Received:
Applicant/Agent/Contact Person: js Received By:
Sign Company:1,14" LIF Phone: Permit No.(s):6 ago _ S
Address: Permit Fee:
State: Zip:
City: Receipt No.: cV0O 1 337
Approved By:
Sign Company C.C.B.#: Date of Approval:
Expir ti n Date: Ekpiratidd bate:
City of Tigard Business Tax#:
(or) Expiration Date: / / Zoning:: - a5/
Metro Business License#:
Expiration Date: Electrical Permit Required? Yes Cl No [y/
Proposed Sign: (check as many as applicable) Building permit Required? Yes C) No
Permanent ❑ Freestanding ❑ Freeway ❑ Rev.t2t27,96 BcurpinlmaaterMspa.doc
Temporary Wail ❑ Electronic ❑ l /
Other r2 w��
Billboard ❑ Balloon �it9Qd, ./vo4
Sign Dimensions:
Total Sign Areas(sq. REQUIRED SUBMITTAL ELEMENTS
Total Wall Area(sq. ft.):
Direction Wall Faces: (drde one) N S E W NE NW SE SW U Completed Application Form
Height(ft.): E3//'Site/Plot Plan Drawn to Scale
Projection from Wall: �'(, (2 copies,3 if a building permit is required)
Illumination: Yes E] No ❑ Type: Internal ❑ External ❑ (,Elevations Drawn to Scale
!,
U.L. Label#:
(2 copies,3 If a building permit is required) i
Co � '
PY ❑ , Fee (Permanent Sign,any size).....
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Materials: Fee (Temporary sign)........... ...............$15.00
Are there any Existing Signs at this Location? Yes No ❑
[f Ye;ll NSI fl IN IN/e 111fIeasleff No fisc he sebmitted.) I certify that I am the recorded owner of the
property or an agent authorized by the owner.
NOTE: * If work authorized under a sign permit has not been
completed within ninety days after the issuance of the
permit. THE PERMIT SHALL BECOME NULL AND VOID. Applicant's Signature
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Receipt #: 27200100000000001338
_.+ Date: 04/02/2001
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Line Items:
Case No Tran Code Description Revenue Account No. Amount Due
SGN2001-00058Temp Sign Perm 100-0000-437000 $15.00
Payments:
Method Payer Bank No Acct Check No Confirm No. Amount Paid
Check NELSEN TIRE&AUTOMOTIVE 0 8637 $15.00
TOTAL AMOUNT PAID: $15.00
8637
NELSEN TIRE AND AUTOMOTIVE
13880 SW PACIFIC HWY 24-22/1230 3274
TIGARD,OREGON 97223
503-639-4100 3 DATEc)/
TO THE Q� $ `l7
ORDER OF
DOLLARS
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FOR
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