HomeMy WebLinkAboutPermit Permanent Sign SN-03-29 - RADIO SHACKCITY OF SOUTH BURL,INGTON
DEPARTMENT OF >PLANi Il 4G & 20NDIG
575 DORSET STREET
SOL7H BURLINGTON, VERMONT 05403
(802) 846-4106
FAY, (802) 846-4101
Permit Number SN &-
Application for Permanent Sign Permit
1) OWNER OF RECORD (Name as shown on deed, mailing address, phone and fax #)
2) APPLICANT (Name, mailing address, phone and fax #) T�.a•� 5 S� ..�-
CSoLI srTZ.-Y949' (3�) Tt3Z-F7sr-aZ.ao
3) SIGN LOCATION (include business name, address, & phone #):
11
4) TAX PARCEL ID # (can be obtained at Assessor's Office)
5) STGN ERECTOR (Name, mailing address, phone and fax #): CS'* u%.-s c s �5 �
6) DATE OF ERECTION
7) STGN DATA
WALL SIGNS (list size in sq. ft., illumination, & type
+ FREE-STANDL TG SIGN
such as panel or cut-out letter)
1.
SIZE (in sq. ft.):
2.
OVERALL HEIGHT:
SIGNABLE WALL AREA (in sq. ft.):
TYPE OF ILLUNiIINATION:
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):
91 Applicant Signature:
Date:
_0) Signature ofLand/Building Owner: Date: _
......................................
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sre®eeaa.osaweication: ejected
Code Officer Signature: Date: G `'�
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This drawing contains original design elements created by Twin Slate Signs and is subject to all copyright laws. This drawing is the property of
Twin State Signs and Is Intended ter your review and approval purposes only. It is not to be reproduced, copied or exhibited In any fashion or
shown to anyone outside your organization without the expressed written consent of Twin State Signs. in the event that exhibition occurs without consent,
Twin State Signs expects to be reimbursed $511 in compensation for time and labor entailed in creating these plans. Copyright •
PROOF READING
ONCE YOU HAVE SIGNED AND DATED THIS FORM, THE COPY YOU HAVE PROOF READ IS CONSIDERED FINISHED AND READY FOR PRODUCTION.
ONCE THIS FORM IS RETURNED TO US SIGNED, WE ARE RELIEVED OF ALL RESPONSIBILITY FOR ANY ERRORS THAT MAY BE
DISCOVERED AT ANY TIME IN THE FUTURE.
--%'
Acceplan, Conditions ------------ _.--------- ---------- - "ale---------------------
SpecificaIioIfS
Date
Client
File Nance
Design hy:
Twin State
Signs
14 Gauthier Drive
Essex .Ict., VT 05452
802—f --�-8949
8111-87h -LIIII Fax