HomeMy WebLinkAboutPermit Permanent Sign SN-12-19 - FAMILY DENTALt
Permit Number SN- -
City of South Burlington, Vermont
Application for Permanent Sign Permit
1) OWNER OF RECORD (Naniq as shown on deed, mailing addre�s s, phone and fax #)
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(Name, mailing addreS$, phpne and fax
3 SI OCA ION (i clude bus' a name, a dr ss, &phone #):
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4) TAX PARCEL ID # (can be obtained at Assessor's Office)
SIGN �RFCTOR (Name, mailing 4ddF9*, phone anA fax #):
7) DATE OF ERECTION--Z c - Q
8) SIGN DATA
WALL SIGNS (list size in sq. ft., illumination, & type
such as panel or cut-out 1 ter
FREE-STANDING SIGN
2. '
OVERALL HEIGHT: I
SIGNABLR WALL (in sq. ft.):
TYPE OF ILL ATION:
NOTE: A scaled rendering bftach proposed sign must be submitted illustrating the color of the sign and
noting the dimensions of each sign.
9) DATE OF DESIGN REVIEW P OVAL (if applicable):
10) Applicant Signature: Date: 3'
11) Signature of Land/Building Owner: Date: Y — 2 - Z
Do not write below this line
Fee: _ 1 AP lie tion: cted Dpproved
l Code Officer Signature: �� Date:
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