HomeMy WebLinkAboutPermit Permanent Sign SN-05-16 - YAGERL)EF I-F'irP,/IE11TT ,nF PLA1 J1NH, 3 "k, ' 01-ITITUI
575 DOPSET STMEE T
SOUTH BUIRLENGTON, VEi DA01,IT 05403
(802) 346-4106
FAN, (802) 846-4101
Permit Number SN- J -
ppl icai c�n for Permanent Sign Permit
I) =01)KNER OF RECORD (Name as shown on :deed mailing address, phone and fax #)
2) APPLICANT (Name, mailing address, phone and falx, #) ,,
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3) SIGN LOCATION (include business name, address, w phone #): / J / 00-r J.c, ¢ J4.
4) TAX P AR_CEL ID # (can be obtained at Assessor's Office)
5) SIGN ERECTOR (Dame, mailing address, prone and fax #):
5) DATE OF ERECTION W 1 OS'
7) SIGN DATA
WALL SIGNS (list size in sq. ft., illumination, & type
such as panel or cut-out letter)
FREE-STA'I\JDING SIGN
I .
SIZE (in sq. ft. ):
2.
OVERALL HEIGHT:
SIGNAELE 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 REVIEW APPROVAL (if applicable): Z1 �` c/ S
9) Anplicant Signature: 6 Date:
It?) Signature of Land/Building )caner: �� �/ Date:
Fee:
Cede Officer Signature:
Do not write below this line
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