HomeMy WebLinkAboutPermit Permanent Sign SN-13-08 - CHAMPLAIN MEDICALPermit Number SN- - o
City of South Burlington, Vermont
Application for Permanent Sign Permit
1) OWNER OF RECORD (Name as shown on deed, mailing address, phone and fax #}
'1
APPLICANT 2
(Name, mailing address, phone and fax #)
3) SIGN LOCATION (include business name, address, & phone ft
7 a Pai F.i�(�11 T�.lY��., S 1?SL}.1 t1 o0 jYl \JT c0s 0:5
4) TAX PARCEL ID # (can be obtained at Assessor's Office) j— C,
5) SIGN ERECTOR. (Name, mailing address, phone and fax #):
7) DATE OF ERECTION
8) SIGN DATA i�i, �iq-S>✓ SGGJ.� J ae_c1
WALL SIGNS (list size in sq. d., iilurnination, & type
FREE-STANDING SIGN
such as panel or cut-out letter
SIZE ft.):
(in sq.
3
2.
OVERALL HEIGHT:
SIGNABLE WALL AREA (in sq. ft.):
TYPE OF ILLUMINATION:
NOTE: A scaled renderingof each proposed sign must be submitted illustrating the color of the sign and
noting the dimensions of each sign.
9) DATE OF DES GN RE EW APPROVAL (if applicable):
10) Applicant Signatu - ._ Date:1 t 13
11) Signature of LandBuilding Owner: Date: Z-Z YXiti
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Do not write below this line
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Fee: � ✓ is tion: ected p rQv
Cocle Officer Signature:.
Date: /;�3
53" by 18" name panel with premium vinyl graphics
Designs are copywrite 0 2012 by Design Signs, Inc. and may not be used without permission.
Champlain Medical Associates
Replacement street sign panels
802-872-9906 January 15, 2013
designsignsvt.com