HomeMy WebLinkAboutPermit Permanent Sign SN-06-53 - VT DERMATOLOGYPermit Number SN-
City Of South Burlington, Vermont
Application for Permanent Sign Permit
1) OWNER OF RECORD (Name as showh on deed, mailing address, phone and fax #)
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2) APPLICANT (Name, mailing address,
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3) SIGN LOCATION (include business nE
)(4) TAX PARCEL ID # (can be obtained at
S) SIGN ERECTOR (Name, mailing ad
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7) DATE OF ERECTION
8) SIGN DATA
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me and fax 4-9�.3
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address, & phone #):
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ssessor's Office) _
phone and fax #):
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WALL SIGNS (list size in sq. ft., illumination, & type
FREE-STANDING SIGN
such as panel or cut-out letter
SIZE (in sq. ft.): /
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2. `7
OVERALL HEIGHT: r
SIGNABLE WALL AREA (in sq. ft.):
TYPE OF ILLUMINATION:
011
NOTE: A scaled rendering of each proposed sign
noting the dimensions of each sign.
9) DATE OF DESIGN REVIEW
10) Applicant Signature: ; "_LM
11) Signature of Land/Building Owner:
be submitted illustrating the color of the sign and
(if applicable):
Date: " vla
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Do not write' below this Dine
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Fee: Applic,ation: 1 ❑ RejecteA pproved
Code Officer Signature:
Date: � � " 7'
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Appr.
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DERMATOLOGY
VERMONT DERMATOPATHOLOGY
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