HomeMy WebLinkAboutPermit Permanent Sign SN-11-54 - TRIMEDPenult Number SN- r
City Of South Burlington', Vermont
Application for Pcmianclit Sign Pcrtnit
1) O rtJ R OF RfCOI (Nat as hogs oil deed, i Will% address, pl ite and fax 11)
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2) APPLIC. INT (Narnu MAIIII add es , Pilo loan ax II Gl
003
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3)
--SIGN�OCA'IO (n a medJre , fi phone
4) TAX PARCEL ID N (cut be obtained at Assessor's Oflicc)__ t(
5) SI'OIN` hRVC-1.OR ((Name, tuailing addiess, pltonc and fax 11): i t i(i
(A O �.�.r1 Z `� L.. t,% 4 � 11 A f J It V 1 �1 f Y c 3
7) DAIT OR FREC1'ION— �� t — _•�G {
R SION DATA
i WALL SIGNS (Im tire in vq. ft., iittrninatior, ltcRc ryye l'R13GS1'ANgING SIGN
�' s�u,:h ni sncf or cut•at letter) _ _
S17,1; (in
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12. — -i OVERALL IMIU11 ;
SIGNADLR WALL AREA (in sq. R.): 1Y�P' OP LLMMATIpN:-y-
t r _ Vl0-P-1
NOTR.: A scaiod tendering of each proposed sign lnutt bo raboulw ill ustrating the eota of the siga AM
rkdris the dirmubns of oath sign.
9) DATP OF DBION ltl'% -W APPROVAL(if applicable):
10) Applicant Signature: [. i Date: i
11) Signature of LnndMuilding 0i�7tcr:1 Dacc: -LIETl,_'
llo not sTrlte txlotr this line
Fee: A p r*a ' n: cj od
Code U1liccr Sigttalpprovctf
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ure; Date:
TRIOMED
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