HomeMy WebLinkAboutPermit Permanent Sign SN-02-33 - GROUND ROUNDFROM : %i ty of So. B
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FAX NO. : 1 802 658 4748 Oct. 17 2001 03:40PM P2
CITY Ow. SOUTH B RLIN TON
DEPART LENT OF PiAIN NL NG & ZONING
90+ 575 DORSET STREET
SOUTH BIJRLINGTON, VERivIONT 05403
(802) 846.4106
FA�C (802) 846-4101
Permit Number SN-
Application for Permanent Sign Permit.
1) OWINTER OF RECORD (Name as shown on deed, mailing address, phone and fax �)
1-3 ,^� w C, 0 /, -,
2)
'ANT (Warne, mailing address, phone and fax #)
3) SIGN LOCATION (include business name, address, & phone #):
1l, 33 1-f/1 //i5r7; y
4) TAX PARCEL. ID # (can be obtained at Assessor's Office
5) STGN ERECTOR (Name, mailing address, phone and fax it):
6) DATE OF ERECTION
71 STGN DATA
WALL SIGNT S (list size in sq. ft., illurnination, & type
FREE-STANDING SIGN
such as panel or cutout letter
1. c� (� n e; rain 1 � L, ic.' �► 5��
�
SIZE�in sq. ft.):
'c, W� A
4 i4s�
2
OVERALL HEIG T-
SIGNABI. E WALL AREA (in sq, ft.)-.
TYPE OF ILLUIv1TN'ATION:
2� vJ
�.�..... 3%.OIk, 14;;uucamg or cacn proposca sign must oe sumutten Must ating the color of the sign and
noting the dimensions of each sign.
S) DATE OF DESIGN REYWW APPROVAL (if applicable):
9) Applicant Signature: L � �C` Date: j' --',
10) Signature of Land/�/idi ng Owner: Date;cil'r-a?k_o �
e■•sooe•o■e•.00a.o■e•oeo�eweeeeweee000uee•00000■ee000ee�oo®moao�soso•oo■■m•®oeaams■e•■saeewaees�see�e
Do not write below this line
eeeee■eae•e e•ee esee)eee�eeee0oseasa�ou■ew.ae■s.■•ou•••..ee.•■e..••e•..eoeseeweooe• •eM.a••ues+■•N
Fcc: �—__ A licatien: ❑Rejeoted G7ApprovCd
Code Officer Signature: `�J �/' �. Dam:
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Attcntion: Tawn/City ot`.J �\f a%D Date:
street.
City/State/Zip:
Landlord Authorization Form
FORM MUST BE SIGNED BY OWNER OF PROPERTY
A As owner of _� D'S�i`��TV� � c> - � )r' i n 0
I hereby authorize Jennifer IZobichcudlris Loughlin Corol BuQbee or
Hazel Hopkins of Barlo Signs Company to -APPLY FOR SIGN PERMITS for this
site.
Signed: '�_A44
-
Printed: X K f 14 C-d
Address: X 6 3 3 ZJ 1S 7-V iti /f P-
.*►+... *.......m..a•••1♦era+.•.•... ••.•♦.♦.♦a•aa.r....... .... ....... araaaa+ra.a•.....a«...a
As owner of /yiGlil STD w f�jh��tl> /lU-TULU (.17"
1 hereby authorize Don feed or a representative
of
Barlo Signs to APPEAR BEFORE THE PLANNING BOARD, SIGN REVIEW BOARD and/or the ZBA
for this site
Signed: qLfx_� L&--t-6
Printed:
Address. 1A 37, .TQit_ 13,
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Job Reference
Job #
PLEASE FAX BACK IMMEDIATELY & MAIL ORIGINAL.
to the attention of ];�A Fax # 603-882-7680
IEl-d ZO/ZO d 898-1
0891Z88E09i
sul's °Ilea-Aodf HAI Z0-8I-1nr