HomeMy WebLinkAboutPermit Permanent Sign SN-07-04 - ELECTRIC BEACH7
CITY OF SO U' -h-I BUR, .II�HNG1 ON
DERL ART1 3 "11,TT C)F P'LAD�_ TING & "0T`TTIl`TG
575 DORSET STREET
:SOU` i'l4- BUPLE,iGTON, S1ERPf01'.TT 05403
(862) 846-4106
EAICK (802) 846-410f
Pen -rift Number SN- 0
Applicatio for Pemaanent Sign P.einlYt
l) OW NER OF RECORD (Nan-ie as shown on deed, mailing address, phone and fax #)
2) APIjLT AIVT (T,Tame, mailing address,.pbone acid fax
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3) SIGN LOCATION (include business name, address, & phone #). yiq;y -
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4) TAX PARCEL ID # (can be'obtained at Assessor's Office)
5) SIGN ERECTOR �tl me, mailing address, phone and. fax #):-
6) DATE OF ERECTION
7) STGN DATA.
WALL SIGNS (list size in sq. ft., illumination, & type
FREE-STANDING SIGN
such as panel or cut-out letter)
SIZE (in sq. ft.):
2.
OVERALL HEIGHT:
SIGNAELE 'WALL AREA (in sq. f ):
TYPE OF ILLUN NATION:
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�. �... +. xC 1xlLGLl11�,' v! a-dua Proposea sign must be submitted illustratixig the color of the sign and
noting the dimensions of each sign
8) DATE OF DESIGN REVIEW APPROVAL (if applicable):
9) Applicant Signature:
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Fee: S
Do not write below this Hine
ion: ❑ ected
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Date:. ? '
Co,,de Officer Signature:
Date: �`
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