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HomeMy WebLinkAboutPermit Permanent Sign SN-04-40 - 4X4 CENTER6 0 Permit Number SN- - / City of South Burlington, Vermont Application for Permanent Sign Permit 1) OWNER OF RECORD (Name as shown on deed, mailing address, phone and fax #) M%cN4AaL. VW Pwea� ih4- itiiA%N S� . �s.Si_x sv\�c \c,J V Sn�z_ gGti- 2) APPLICANT (Name, mailing address, phone and fax #) `'M`= 4-X 4- OlatSr cQ,. (3 trr+►9N 44LLE66 3v\J2u tZ(2tik--o4,� v CSk�o'I 8'©2 F6c+ $sGS- ffi'Z 536kF 3) SIGN LOCATION (include business name, address, & phone #): i * 4�ck &3 1=TN�-N K1(r CRA3 1>fZ . _S0cl-c-4 3uj_-L I(Grz k o tQ U i ©S4,0"Z . 4) TAX PARCEL ID # (can be obtained at Assessor's Office) 064-0 -- Ooo6} �> 5) SIGN ERECTOR (Name, mailing address, phone and fax #): + tka (+Y-4 7) DATE OF ERECTION C)I0 -7 / ? C)C — , 8) SIGN DATA WALL SIGNS (list size in sq. ft., illumination, & type FREE-STANDING SIGN such as panel or cut-out letter) I. S� ',EvA SIZE (in sq. ft.): (�1j 2. HEIGHT: SIGNABLE WALL AREA (in sq. ft.): TYPE OF ILLUMINATION: 1$©Q S t't NOTE: A scaled Fendering of each proposed sign must be submitted illustrating the color of the sign and noting the dimensions of each sign. 9) DATE OF DESIGN REVIEW APPROVAL (if applicable): 1 10) Applicant Signature: ��� Date: $' 6 1 0 4, 11) Signature of Land/Building Owner: �f Date: 19 jb ©`+- . Do not write below this line •••••••••••••J•�•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• Fee: W lication: Re' cted pproved Code Officer Signature: Date: y f�R EM Al look- 1