HomeMy WebLinkAboutPermit Permanent Sign SN-17-25 - 120 KIMBALLPermit Number SNJ—I-J-�
City of South Burlington, Vermont
Application for Permanent Sign Permit ��zztv
1) OWNER OF RECORD (Name as shown on deed, mailing address, phone and fax #)
2) APPLICANT (Name, mailing address, phone and fax #)_ /
3) SIGN LOCATION (include business name, address, & phone ft
4) TAX PARCEL ID # (can be obtained at Assessor's Office;
5) SIGN ERECTOR (Name, mailing address, phone and fax #): �J(1S��,y�f►
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7) DATE OF ERECTION_ _ __ 1, _� —
l 8 SIGN DATA
J WALL SIGNS (list size in sq. ft., illumination, & type FREE-STANDING SIGN
such as panel or cut-out letter
1. SIZE (in sq. ft.): • 3
2. OVERALL HEIGHT: let
SIGNABLE WALL AREA (in sq. ft.): TYPE OF ILLUMINATION:
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NOTE: A scaled rendering of each proposed sign must be submitted illustrating the color of the sign and
noting the dimensions of each sign.
9) DATE OF DESIGN REVIE APPROVAL if a plica ): — `
10) Applicant Signature: Datc:
11) Signature of Land/Building -tf�� Date: ZO / 7
Do not write below this line
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Fee: Application: Rejected ❑ Approved 0
Code Officer Signature: Date:
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3 SIGN APPLICATION
CITY OF SOUTH SURLINGTON, VERMONT
Date it
19oot
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Permit Number l' /' /
Applican L
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No.
Town or Ci' y/ ' /' State t- / Phibne%� N"a.
Location of sign
Nam of bus�.N-o . Street
Square footage of sign -/� Height of Sign /
Estimated cost Date of erection
Name of Erector
Address
Town or City State Phone No.
Consent of Owner:
The above named person is duly authorized to make
application on my behalf. I believe the statements contained
herein are true to the best of my knowledge.
Signsture'of Applicant Signature of Owner
DO NOT WRITE BELOW THIS LINE
Application: REJECTED APPROY[ED Date
Reason for rejection 1 /
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Issued to /�4 /,
Fee Computation �` `�-�' Code Officer A�''��
Date / 19�
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