HomeMy WebLinkAboutPermit Permanent Sign SN-03-23 - CHAMPLAIN PHOTO0
DEPA I ME T C)IF
575 DOi?SET STREET
SOUTH BURLINGTON, ':iE xMOPTT 05403
(802) 846-4106
FA1'k (802) 846-4101
Penrilt Number SN-0 �7 -
Application for Perm anent Sign Permit
1) OWNER OF RECORD (Name as shown on deed., mailing address, phone and fax #)
2) APPLICANT (?1 me, mailing ad ress, phone and fax #)
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3) SIGN LOCATION (include business name, address, & phone #):
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4) TAX PARCEL ID # (can be obtained at Assessor's Office
5) SIGN ERECTOR Q*-,e, mailing address, phone and fax #):
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6) DATE OF ERECTION
7) SIGN DATA
WALL SIGNS (list size in sq. ft., illumination, & type
FREE-STANDING SIGN
such as panel or cut-out letter)
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OVERALL HEIGHT:
SIGNABLE WALL AREA (in sq. ft.):
TYPE OF IL,LUI4IINATION:
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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):
9) Applicant Signature:
Its) Signature of Land/Building Owner:
Fee:
Code Officer Signature:
Do not write below this line
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Date: J o3
, Date: s, d 3
E�Approved
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Date:
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