HomeMy WebLinkAboutPermit Permanent Sign SN-05-46 - ACUPUNCTUREE
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DERIAERT MM EEl`T 17, OF PLAII'l-MINAG. 42t ',Ar)1\'TJU\TG
575 DORSET STREET
SOLTH BLIWLENGTON, VERTIAOINT 05403
(802) 346-4106
FAX (802) 846-4101
Permit Number SN- 6
Appliratio n for Perrina-ment Sign. Peimit
OF RECO-RD 9&aine as shown on deed, mailing address, phone
2) APPLICANT (1,4wi-ne, mailing address, phone and fax
3) SI N LOCATION (include business na�,c, ad#ess, & phone #)- 4!7
1-1700'A
00�
4) TAX PARCEL T" # (can be c,otained at Assn ssGA's Office)_
Jq(
5) ST N ,RIECT-"'R (Name, i-nailing addross, phone a fax 9):
6) DATE OF ERECTION
7) SIGN DATA
fax
WALL SIGNS (list size in sq. ft., illumination, & type
such as panel or cut-out letter)
FREE-STANDING SIGN
SIZE (in sq. ft.):
J OVERALL HEIGHT:
SIGNABLE WALL AREA (in sq. ft.):
TYPE OF ILLUMINATION:
NOTE: A scaled rendering of each proposed sign must be submitted illustrating the color of the sign and
noting the dimensions of each sign.
8) DATE OF DESIGN REVI4�/Y APPROV
9) Applicant Si
1 -1
10) Signature of Land/Building
Fee:
Code Offlicer Signature:
W,
Date:
MWIM�Z�— a e:
write below this line
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