SGN2003-00033 r
CITY OF TIGARD
SIGN PERMIT
DEVELOPMENT SERVICES PERMIT#: SGN2003-00033
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2
/11/03 PARCEL: 25102S102AC-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: P
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 ex 10 days from validity date.
APPROVED BY:
PERMITTEE SIGNATURE: L✓'�
DATE: 2/11/03
CITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2003-00032
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/11/03
PARCEL: 2S102AC-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: P
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 expir 10 days from validity date.
APPROVED BY:
PERMITTEE SIGNATURE:
DATE: 2/11/03
SIGN PERMIT APPLICATION
CITY OF TIGARD 13125 SW Hall Blvd., Tigard, OR 97223(503)639-4171 FAX: (503) 684-7297
GENERAL INFORMATION S(-Q?-a47Z- -470e-75
Name of Development/Project FOR STAFF USE ONLY
Site II&ARD DGIVI-AL 114M.76-S
Address/ Street Address Permit No.:
Location 12-120 SLA ?AC11 PIC/ 14"11 Expiration Date:
Suite/Bldg.# City/State Zip
1 11&AV-D 9-1223_ Receipt#:
Name Approved By.:
Property ;412TUlq U)16-CoQ DDS Date: 170/403
Owner Mailing Address Suite Map/TL#:
)2720SLiP4CX(0f&,i1 42, Zoning:
City/State Zip f?23 Phone
T&A 112 D Diq rSp
3)5SS-927/ Electrical Permit Required? 0 Yes R No
Tenant or Name
Business Building Permit Required? [-1 Yes E] No
Name Rev.01-Jul-02 i:\curptn\mastersVevised\sign permit app.doc
Sign
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuance.a without the required submittal elements)
copy of all city/state Zip Phone
licenses are
required if F-1 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 ❑ Freeway size requirement: 81/2" x 11", or 11" x 1T'
Sign Temporary ❑ wall 1:1 Electronic
(Check all that ❑ Other E] Billboard E] Balloon ❑ 2 copies of elevations, drawn to scale
apply) (3 copies, if a building permit is required)
❑ New sign? 9 Alter to existing sign? size requirement: 81/2" x 11", to 24" x 36"
Sign Dimensions: SY, Z
EJ $30.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): E] $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): but must include dimensions of wall face and
Projection From Wall (inches): sign placement.
Copy: • Wall signs do not require sitelplot plans.
Materials: V)IVY L,1 ♦ Freestanding signs over 6 ft. required a
Will sign have illumination? El Yes 0 No building permit.
Type: El internal R] External + If work authorized under a sign permit has not
Are there any existing freestanding or wall sig Asat this been completed within ninety (90) days afterthe issuance of the permit, THE PERMIT WILL
location, including wall signs that overlap a tenant space? BECOME NULL AND VOID.
[I Yes Co 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 �-11— day of 20
Signature of Owner/Agent
927/
Contact Person Name one No.
CITY OF TIGARD 2/11/2003
13125 SW Hall Blvd. 2:36:48PM
Tigard,Oregon 97223
(503) 639-4171
Receipt #: 27200300000000000544
Date: 02/11/2003
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2003-00032 [SIGN] Temp Sign Perm 100-0000-437000 15.00
SGN2003-00033 [SIGN]Temp Sign Perm 100-0000-437000 15.00
Line Item Total: $30.00
Payments:
Method Payer User ID Acct./Check Approval No. How Received Amount Paid
Check TIGARD DENTAL MET 170 In Person 30.00
Payment Total: $30.00
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