HomeMy WebLinkAboutPermit Permanent Sign SN-03-11 - AFFORDABLE DENTURESMAR-18-2003 16:12 FROM RFFUHDHbLL (-HRL tNl lu 71i3e1G7G�r_�� r.eJG
Mar 18 03 03:19P Brian Precourrt 802-985-2250 P.2
CITY OF SOUTH BURLINGTON
DEPARYXKNT OF PS.AI'INING & Z4N104C
575 DORSET STREET
SOUTH BUR INGI'ON, VERMONT 05408
(802) 846.4106
FAX (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 #)
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2) APPLICANT (Name, mailing address, phone and fax #)
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3) SIGN LOCATION (include business name, address, & phone #):
4) TAX ?ARCEL 1D # (can be obtained at ,Assessor's OfI"ice)_Z :5 C C,�- I S C, b0
S) SIGN ERECTOR ame, mailing address, phone and faxr#): Ke- r'S k n e r gh S
iriq I'l'lIr.r C $sv.� twf �rnA /�-� Y�__ 40
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6) DATE OF ERECrION Lj oo
7 SIGN DATA
WALL SIGNS gist size in sq- ft-, illumination, & type I FREE-STANDING SIGN
such as panol or cut-out letter I _
1. 1L4L_0M;A 7� 1ZE (in sq. R.):
2. OVERALL HEIGHT.-
SIGNABLE WALL n sq. fL ): TYPE OF ILLUN NAMN:
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NOTE: A scaled rendering of each ptnposcd sign must be submitted illustrating the color of the sign and
noting the dimesesuiens of wch sign.
8) DATE OF DESIGN
9) Applicant Signature:
10) Signature of Land,Building
APPROVAL r.Uit 1C):
Dam- 3^ I S - C)3
Do not write below this line
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Fee- _ — ication: t ',Approved
Code Officer Signature: Date;
TOTAL P.02
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