HomeMy WebLinkAboutPermit Permanent Sign SN-07-70 - PSYCHOTHERAPY1) OWNER OF
Permit Number SN-�-�
City of South Burlington, Vermont
Application for Permanent Sign Permit
ORD (Name as shown on deed, mailing address, phone and fax #)
2) APPLICANT (Name, mailing address, phone and fax #)
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3) SIGN LOCATION (include business name, address, & phone #): 3
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4) TAX PARCEL ID # (can be obtained at Assessor's Office
5) SIGN ERECTOR (Name, mailing address, phone and fax #):
7) DATE OF ERECTION
8) SIGN DATA
WALL SIGNS (list size in sq. ft., illumination, & type
FREE-STANDING SIGN
such as panel or cut-out letter
1 •
SIZE (in sq. ft.):
2•
OVERALL HEIGHT:!
SIGNABLE WALL AREA (in sq. ft.):
TYPE OF LUMINATION:
NOTE. A scaled rendenng of each proposed sign must be submitted illustrating the color of the sign and
noting the dimensions of each sign.
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W t,C;` S+
9) DATE OF DESIGN REVIEW APPROVAL (if applicable :
10) Applicant Signature: Date: O p %
11) Signature of Land/Building Owner: �� Date: to
Do not write below this line
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GO
Fee: plication: ejected �A�pprov
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Code Officer Signature
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Date: v J l
1
402, w1-�6x
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viClarla Coivtn, UCSWJ, UK
Dan 5leinbauer, mt>y uoc
i f�1.t • _� � >.�; .1�a.-.'. •M. i1 Cf NIY�::.4
Emily U. Thurber, mA