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HomeMy WebLinkAboutPermit Permanent Sign SN-06-73 - GE HEALTHCAREPermit Number SN- 0 6 - City of South Burlington, Vermont Application for Permanent Sign Permit 1) OWNER OF RECORD (Name as shown on deed, mailing address, phone and fax #) �P1-atJrJS - 'V� L- --C_ 10 (ox CJ33B ;� 2) APPLICANT (Name, in address, phone and fax #) l /Qz/r0 659/ Q lJ L47X �-10"70 ,r _ sf7,) d P/n 9 - 6P 4p 3) SIGN LOCATION (include business name, address, & phone ft -� ..� 4) TAX PARCEL ID # (can be obtained at Assessor's Office) 5) SIGN ERECTOR (Name, mailing address, phone and fax #): 7�,y STiYIx- �i6/✓S _ 1/7- _72- - &94y 1= E3-2fq -c�-Z� 7) DATE OF ERECTION 1 M 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 ft.): 2 2. OVE HEIGHT: 0 f- C SIGNABLE WALL AREA (in sq. ft.): TYPE OF ILLUMINATION: 5P07-csc /Z n NOTE: A scaled rendering of each proposed sign must be submitted illustrating the color of the sign a4d noting the dimensions of each sign. 9) DATE OF DESIGN 7(i a V I L ): 10) Applicant Signature: - Date: % `cc 11) Signature of Land/Building OwnerDate: // / 06 Do not write below this line •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• ••••••••••• Fee: A is 'on: Rejected pprove Code Officer Signature: !J Date: J� QUANTITY r 'et SURVEY ■ N/A ❑ Required [:]Completed APPLICATION Apply infield ❑ Apply in shop ❑ Ship to customer ❑ Ship to sub -contractor ❑ Customer pick-up SURFACE N1st surface ❑ 2nd surface Aluminum ❑ Glass ❑ Acrylic ❑ Lexan ❑ Flexface ❑ Wood ❑ Other COPY 1 Black =7 6 1 /8" ealthcare 4'-8" 'THIS DOCUMENT IS OWNED BY, AND THE INFORMATION CONTAINED IN IT IS PROPRIETARY TO, POBLOCKI SIGN COMPANY, LLC. BY RECEIPT HEREOF THE HOLDER AGREES NOT TO USE THE INFORMATION, DISCLOSE IT TO ANY THIRD PARTY, NOR REPRODUCE THIS DOCUMENT WITHOUT THE PRIOR WRITTEN CONSENT OF POBLOCKI SIGN COMPANY, LLC. HOLDER ALSO AGREES TO IMMEDIATELY RETURN THIS DOCUMENT UPON REQUEST OF POBLOCKI SIGN COMPANY, LLC.' Existing © Copyright By Poblocki Sign Company, LLC. POBLOCKI 6 1 6 0 C 0 M P 0 0 1 414. 453, 4010 lax: 414.453.3070 922 S. 701h St., West Allis WI 53214 PROJECT: GE Healthcare 1 Green Tree Dr. Burlington, VT This document represents only an approximation of material colors specified, Actual product colors may vary from this print or digital Image. CUSTOMER APPROVAL: AUTHORIZED SIGNATURE DATE WORK ORDER NO. ff- E15608% REVISION NO. 03 mgl qty. 10/13/06 MISSING INFORMATION ❑ Color (s) ❑ Copy ❑ Accurate size (s) ❑ Clean artwork ❑ Other REPRESENTATIVE Stanley Ferstadt DRAWN BY Lynne Holton DATE 05/0.( SCALE SHEET 01 DRAWING NO. 34954