HomeMy WebLinkAboutPermit Permanent Sign SN-12-71 - USA RISK GROUPPermit Number SN-�-
City of South Burlington, Vermont
Application for Permanent Sign Permit
1) OWNER OF RECORD (Name as shown on deed, mailiniz address, phone and fax #)
2) APPLICANT (Name, mailing address, phone and fax #)_ h-�•�
3) SIGN LOCATION (include business name, address, & phone ft
1195 wit 1ts6N-,2oad -, i'enn•e.dv ram_
4) TAX PARCEL ID # (can be obtained at Assessor's Office) % (O • I ,
5) SIGN ERECTOR (Name, mailing address, pphone and fax ft
ershne 6t - 2"( evs LLrt- -- —
&r _" ,' v-r a5 40 3 P s 8'(09.4 - I
F: 65F •6351
7) DATE OF F,RECTION T8D
8) SIGN DATA
.401
WALL SIGNS (list size in sq. ft., illumination, & type
FREE-STANDING SIGN
such as panel or cut-out letter
I.H1 VtnY1 e r �
SIZE (in sq. ft.):
cam. +} x 30 ' L•on
2. I.41 (p SF
OVERALL HEIGHT:
SIGNABLE WALL AREA (in sq. ft.):
TYPE OF ILLUMINATION:
33 (o yr F
NUTS: 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): _
JrWe a,jV<s 0&rpo,ra o n t4-�4tho Af
10) Applicant Signature: A ; Q� . 1-i U Date:�-
Inve66.ea Verb, on �-
11) Signature of Land/Building Owner: $f s (,j',lt, VW ,f,� ate: I L• 'Z?• I �—
..............................................................•...•...........
Do not write below this line
/ ! Fee: 5 �__. ationectedr o
Code Officer Signature Date:
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