HomeMy WebLinkAboutPermit Permanent Sign SN-14-50 - CHAMPLAIN MEDICAL ASSOC�v
Permit Number SN- -
City of South Burlington, Vermont
Application for Permanent Sign Permit
1),qWNER OF RECORD (Name as shown on deed, mailing address, phone and fax #)
3) SIGN LOCATION (include business name, address, & phone #):
4) TAX PARCEL ID # (can be obtained at Assessor's Office) 45 - t/ 715 0 yo tl
5) SIGN ERECTOR (Name, mailing address, phone and fax #): / iI S
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7) DATE OF ERECTION
8 SIGN DATA
WALL SIGNS (list size in sq. ft., illumination, & type
FREE-STANDING SIGN
such as panel or cut-out letter
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SIZE (in sq. ft.):
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2.
OVERALL HEIGHT: /r
SIGNABLE WALL AREA (in sq. ft.):
TYPE OF ILLUMINATION:
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 REVIEW APPROVAL (if applicable): /
10) Applicant Signature. Date: 1011 % / / L/
11) Signature of Land/Building Owner:-_ Date:/
Do not write below this line
Fee: Ap on: Rej ted ❑ Approved
Code Officer Signature: Date:
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