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Permit Permanent Sign SN-12-25 - 1775
` s f Permit Number SN- - City of South Burlington, Vermont Application for Pernlanent Sign Permit 1) OWNER OF RECORD (Name as shown on Peed, mailing address, phone and fax #) krwe,s S a&r) Elrmz>nf' 30 Lq&!..h br. SS o w- n n vT o54ol 8o2.Fs403.2311 �P) �so2•&63.23{3(�� 2) APPLICANT (Name, mailing address, phone and fax #) 3) SIGN LOCATION (include business name, address, & phone ft 1 1"1i 9 Ai' II1;JZ n ��c� . ArrA , 8MrI(rl.G-1An. a S44 O 4) TAX PARCEL ID # (can be obtained at Assessor's Office) 1910 • O 1 `f `7S 5) SIGN ERECTOR (Name, mailing address, phone and fax #): 1pf���tb� .O. i r* 85'10 , ass 2� e1 e✓�'• , i o 54 51 U SsV2 qQo (0 rpl 8`T2• qto rF) 7) DATE OF ERECTION HQAI 20 ( Z 8) SIGN DATA WALL SIGNS (list size in sq. ft., illumination, & type FREE-STANDING SIGN such as panel or cut-out letter) SIZE (in sq. ft.): G.S" 3c 24" s!o 5 F 2. OVERALL HEIGHT: 1 SIGNABLE WALL AREA (in sq. ft.): TYPE OF ILLUMF�ATION: &T avi h C1 iN u i b: 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: 044WAeal- ^ Date: 5. 1 S. V1 11) Signature of Land/Building Owner: 041iiz,y� Date: 5 • I S• 17- ••••.•.••••....•....................•.•.....•••••..•...••.•.......•.•......... Do not write below this line Fee: �✓ lication: 'ected ppro Code Officer Signature: Date: 75 co OMary A. Stanley, MID Vermont Gynecology 06 PXHoENI HYSICALTHEPAPI; PLC — . I Zydus Noveltech Inc. o Nancy Carlson Fisher, MD Lumina Designs are copywrite © 2012 by Design Signs, Inc. and may not be used without permission. ICV 1775 Williston Road 802-872-9906 Add Dr. Stanley to street directory © 2012 designsignsvt.com May 15, 2012