HomeMy WebLinkAboutPermit Permanent Sign SN-04-62 - HIGHER GROUNDL IE - F4Ti /I 1'T T OF PLA Ti ITITC-T
575 DOI-.SET STREET
SOUTH BURL NGTON, VEE,MONT 05403
(302) 346-4106
Efi2[ (302) 846-4101
Permit Nunnber SK-o- ,
ppliCat n for Pe anent Sign Pew t
1) IMMINER OF RECORD (14ame .as shown on deed, inailing address, phone and fax #)
2) APPLICANT (Naime. mailing address,
Old 2,-�� JA
gone and fax #)
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3) SIGN LOCATION (include business naan , address phone #):
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4) T-AXPAR_CEL ID # (can be obtained at Assessor's Office)
5) STGN ERECTOR Q-dame, mailing address, phone and fw-c #):
6) DATE OF ERECTION
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WALL SIGNS (list size in sq. ft., illumination, & type
such as panel or cut-out letter)
2.
SIGNAELE WALL A,,4 (in sq. ft.):
, E-STAI�IDE\TG SIGN
SIZE (in sq. ft.):
OVERALL 1MC-THT:
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 AP AL
9) Applicant Signature:
W) Signature of Land/Building Owner:
Da not wvrite, he3ow
applicable): k;
Date:
Date: / 3 /S
�`..,sE,c�.�An,�®n..•on�ar ama,00we.
tern i1 Approved
Code Officer Sign] ature.;
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