HomeMy WebLinkAboutPermit Permanent Sign SN-99-19 - MIDASSIGN APPLICATION
CITY OF SOUTH BURLINGTON, VERMON'I'
19 Permit Number
Date ►
Applicant $ C`q'ot`� �►J�1V2 S¢,C'v ��.� c f,Ss
.90No. Street
00. LwY" 1
Town or City
State
Location of sign �� S iva M�t�n-5 �IVQ'
Name of business No. Street
Pc,,,nV, %AcA< L+) 71- 4 A 0 ay.c� CL) ato. G Y.,) "I � /�
Square footage of sign y0 d S-�nc:•.� Height of Sign /If
Estimated cost �C14 O Date of erection T%,t 3a h
Name of Erector T
4 (a, %jax
Address
Town or City IF State
Consent of Owner:
==� `,f,
• .
The above named person is duly authorized to make
application on my behalf. I believe the statements contained
herein are true to the best of my knowledge.
Signature of Applicant Signature of Owner
DO NOT WRITE BELOW THIS LINE
Application: REJECTED
Reason for rejection_
v
APPROVED Date�� y
Issued to
00
Fee Computation 4d Code Officers
Date 19 �____
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