HomeMy WebLinkAboutPermit Permanent Sign SN-02-59 - LA WEIGHT LOSSPermit Number SN- -
City of South Burlington, Verinont
Application for Permanent Sign Permit
1) OWNER OF RECORD (Name as shown on deed, mailing address, jphone and fax #)
2) APPLICANT (Name, mailing address, phone and fax #) S `y k _
3v-13 L2,11ak, 21 363
3) SIGNyy LOCATION (include business name, address, & phone #):s�-
4) TAX PARCEL ID # (can be obtained at Assessor's Office
5) SIGN ERECTOR (Name, mailing address, phone and fax #): ��,- A_
7) DATE OF ERECTION � /Z / /
8 SIGN DATA
WALL SIGNS (list size in sq. ft., illumination, & type
FREE-STANDING SIGN
such as panel or cut-out letter
6CU .�� -' i'
SIZE (in sq. ft.):
2•
OVERALL HEIGHT:
SIGNABLE WALL AREA (in sq. ft.):
TYPE OF ILLUNIINATION:
Zh
NU iLn. A hcaiea renaenng or 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): z/ 5 d
10) Applicant Signature: Date: d 1-
12 U C 55U
11) Signature of Land/Building Owner: ate: 2
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Fee: Application: ❑ Rejected pproved
e
Code Officer Signature: Date: �� �G 7
r
Proposed new sign placement
LA Weight Loss
150 Dorset Street
Blue Mall