HomeMy WebLinkAboutPermit Permanent Sign SN-99-35 - GET WELLSIGN APPLICATION
Office Copy
CITY OF SOUTH BURLINGTON, VERMONT
Date iJ (o
19
Applicant
Permit Number ��'- �✓
,3eoc-) WI /h<S 10h J
No. Street
P-so. / U,f- Lt--) 1)7
Town or City State Phone No.
Location of sign C?t�,i-tal-II W/ItSley7 J
Name of business No. Street
Square footage of sign Height of Sign
Estimated cost 900 Date of erection 71S! Z5
Name of Erector
Address
r Y!7T 1011,67 7 9/
Town or City J State Phone No.
Consent of Owner:
The above named person is duly authorized to make
application on my behalf. I believe the statements contained
herei re tr e he best of my kpowljed e.
Sigatur of A icant S igna u
ntie- Owner
DO NOT WRITE BELOW THIS LINE
Application: REJECTED ROYE Date LL
Reason for rejection��'
Issued to
Fee Computation �` Code Officer
Date �6 19
aI •
r
Blue Cross Blue Shield
of Vermont
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Pierre Angier, DO
Osteopathic Physician