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HomeMy WebLinkAboutPermit Permanent Sign SN-01-50 - STATE FARMCITY OF SOUTH BL.TRLINGTON DEPARTMENT OIL MANNING & ZONING 575 DORSET STREET soum BURLINGTON, VE1tN O NT 05403 (802) 846-4106 FAX (802) 846-4101 Permit Number SN � l -�� Application for Permanent Sign Permit OF RECO (Name as shown on deed, mailing address, phone and fax #) awn/. F14-v t, /35'0 t51z1hv.-1,e Woo •a._v�'!/e?.ram OS�f 3— ��' 02 -!3 >a 2) APPLICANT (Name; mailing address, phone and fax #) 7 8o2- — 4C3s- .2 t/-,Z � .�RN_� __•i�01 i���� Sa N �d'T DS6 �r - 3) SIGN LOCATION (include business name, address, & phone #): .5��4L%E_ 4a.n %%v y41k / ,�, v on �af ,T � rum Ca • /3.� S'��,,•ye_ Re S.-Ye 19Sg2- * 22: 4) TAX PARCEL, ID # (can be obtained at Assessor's Office)_,S__ C SIGN ERECTOR (Name, mailing address, phone and fax #): _ /Nc. / j v t 1, tic L^ve Ah f(,'R.r1t 660 0. 00 6) DATE OF ERECTION 7) SIGN DATA Oq.: WALL SIGNS (list size in sq. ft., illumination, & type FREE, -STANDING SIGIJ such as panel or cut-out letter) -T41 C,b AA 6it- _ ) r, jV - l. SIDE (in sq. ft.). _ i_ 2. 0-v IGHT: SIGNABLE WALL AREA (in sq. ft.): YPE OF ILLUIII`I TION: s. 5y4•�� �,A-vLL- a'1A+4L-e4,e-� NOTE: A scaled rendering of each proposed sign must be submitted illustrating the color of the sign and noting the dimensions of each sign. Q) DATE OF DESIGN REVIEW APPROVAL (if applicable): _ 9) Applicant Signature: _ rT Date: � � z/�- ✓t; s CwS 10) Signature of Land/Building Owner: )2_tV' _..v_ _�L'Date /v --/ - of y/—& j Do not write below this line iasavaiaiY�sYiYiiYsslpo:c+•GiiibY4YYbtl�liYYr Y®iYGOYeGYYYfssii�7.`9f O�rst�ilbaYiwYYYbIiYYi+s�i.ki s�s�oa.�s:�aac�� Fee: /© L-J- olication. Rejected__ Code Officer Signature:__ � Date: gi* kfaw C �'T�rL i y �cl�r .w,V 74�"ese4t s.,,gN I'-s % - �'otrJG/ !)eS,,�,v ✓/si%Ji/�j . f Cl (z PAN f I� IM �� DUALITE - AGENT SIGN ORDER MAIL TO: DUALITE, INC. NO. S 15 3 8 5 7 7 ONE DUALITE LANE WILLIAMSBURG, OHIO 45176 DATE Phone: (513) 724-7100 REGION ORDERED BY SHIP TO NAME NAME ADDRESS ADDRESS CITY CITY STATE ZIP CODE STATE ZIP CODE PHONE PHONE ❑ AGENT ❑ AFE CODE ❑ AGENT ❑ AFE CODE Please review Equipment Section of Agent Resource Guide for freight information. SIGN DESCRIPTION CODE NUMBER QUANTITY PRICE* *Sales tax will be applied at your regional office. TOTAL IMPRINT NOTE: UNLESS OTHERWISE SPECIFIED, DUALITE, YOUR IMPRINT FOR OPTIMUM VISUAL APPEAL & RIEAD BI CLL ITY. RANGE REPLACEMENT PROGRAM Enter dimensions of replacement sign face in the appropriate spot below �I I IN 05 TRIM O SIZE APPROVAL Agency Field Executive IMPRINT STATE FARM l�ri�_ ) INSURANCE O AUTO • LIFE FIRE • HEALTH * Order without signature will be returned TRIM SIZE STATE iARM n I N®R ® E AUTO • LIFE • FIRE • HEALTH TRIM `-% SIZE I - METHODS OF PAYMENT ❑ INVOICE — Regional Office Accounting will invoice for the full amount after delivery. ❑ ONE TIME DEDUCTION (Compensation Deduction) ❑ TIME PAYMENT — May be financed for a period from three months to five years — in three month increments. DOWN PAYMENT (if desired) 5 FINANCE BALANCE FOR MONTHS Z-20456.2 Printed in U.S.A. DUALITE COPY