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IMAGE NATIONAL 9 008
SIGN ADDWS �2 I � � S ; , -
PERMIT NI)MEM'
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NAME OF HUBINESS 5 }� . _
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pWpMTY OWNER
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ADDRESS: Z C
ZONII+iG DISTRICT: 3 OVULAY ZONE: 31 42I 431 OJ.D TOWN: YES — NO
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LACATION pBRbMIT RBQUMD MR THIS BUILDII�iC NANT SPACE? _ � ` ; ;,
I5 AN IlViYROY 'F.MBN'T ' �: • ; :�•;
IF YES, STATE FmtwT N00MER ISSUED :,. ! ' • i. '.�
SIGN TYPE-cirtk any: MOUND ROOF PAOrECrWG SWOMED PORCH WDWW
SIGN STATUS -circle rcgxw 3): '
NO.OF $1DES appsvp�iacc r
OVBMALL SIGN RaCAITt PROM GlOt3]Y17:
124 — FT. OVERALL SIGN DBIENS"s- x
TOTAL SKE•iARPA: Requeaoed ICE -5 SQ. FT. Pbmtiuil�t �� • SQT Ft. cum. Z--
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Bi>ZI iNG oR TENANT SPACE FRONTAGE DudENSION• Fr. SUMDING TYPE
MUCK OF SIGN FROM NEARBSf
RIGHT-OF-WAY: '
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DIl��iSIQNS: 'Low LS PEIRCSNT OF AILOWANCB SM
AIM THM ANY iDGSTING SIGNS ON THIS SITE? IF YES, EXH-AIN
SHOPPING CENTER OR COMMX NAME:
V A I CERTIFY THAT A FICTVRE OF TMS SICIN WILL BE RMM{' "D To M DEPARTMENT of CO11MU�TX
SERYIO6s WTTEV ONE (1) WWK AMR ERECTION
CRON OF THI? SIGN -
I WO[II.D P 3EFi�R A S3.i' T44 INSPEG710N FEE HE ADDED TO TM COST` OF THIS PER?&T TO COVER �
OF THE STA r OF T1W DEPARTMENT OF COMMUMTY MRVICES TAXING THIS PiCTiJFET
'I'�FO COPIES Dl' THE FOLLOWING DOCUMENTATION ARE REQUIRED FOR THE REVIEW OF THIS 5 .
COMPUTED APPLI �Td� I�r 9ecback8 VW XVPD ed alb IvGutiO4
SITE PLAN (dtpiMr4 SPY and Baku)
+ rsiGN BLEVATICNS {dapi�� En airs,
* BUii1SING OR TENANT SPACE ELEV`ATIaN-(depicter frow8e dimemiCnS U4 propasca sign loud4
} LANDSCAPE FLAN keqtind for gmuni signs ("icting the Pig, man= heights "calm)
Sae Samples Attached
SIGN PE MIT FEES:
-PERMIT APPLICATION..................... 3z5.
-SIGN ERECTION ............................. $X, OU PER SIGN FAU PLUS $i, 00 PER SQUARE SOOT OVER 3Z SQTJARE PSET.
-REPLACEMENTOP SIGN PACE IN AN EXISTING CA.EfNET .... S21.OQ PLUS $1.00 PER SQUAAE FQOT QVft 31 SQUARE
(Con�sed 4a, P,��y.
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Sign
Permit Applic9lon
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THE UNDR'C ONW CERTIFIES THAT THE FOREGOING SI[iNATU1 5, SrAT�►1'1^5 ANI]
AND THE INFORMAU4N HEREWITH SUBMITTED ARE IN ALL RESPECTS TRUE AND CORRECT � Tiff SIGN WILL ERECTED AND MAINTAINED IN ACCORDA�NICE WITH ALL APPLICABLE L�1 W$ QF TILL' STA
ZLANA, AND TM
RECT vRI]ih[A gl (, OF CAR,'4jE"ICLAY 'TOV SHIP, INDIANA AND ALA, ACTS AMENI3ATORY iH>r�ET�, AND SHRED FIE
RECT&D LVt'TZ�,I g� {6) !, Q�r; S 4"THE DATE OF ISSUANCE OR T141S PERMIT IS NULL AND VOID.
DEPARTMENT
NT i1COA4 SIGNED CERI'IFI$p by SIGNING TICS APPL[CA7[ON 'T'hAT ALL REPRESENTATIVES OF THE
DEPARTMENT of coMINUNITY SERVICES ARE ADVISORY.
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OWNERS crrATr IlvESS oarlErt rcnlATtr �'rI:SrB�-�
PROPERTY OWjy s NAME LEASE l?RINT-&t!� /. '
BV51NESS OWNER'S NAME (I'LEasE FRIIv'T)
SICrNCOI►p�N4►;;i� , �'�T, 3 L KEONTACTPERSON
ADDRESS., ci 3-3
CITY:
STATE: ZIP: t j 71
THE FOLLOWINO ITEMS ARE CONCERNS BY STAFF OR PRIOR CO CONDITION OF THE(PLEASE INITIAL EACH ITE, ISSUANCE OF THIS PERMIT 'ITNIE ENTS THAT MUST BE ADBERED TO AS A
M INDIVIDUALLY); _
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4) x
5) x
SIGN PERMIT A.PPLICATIQN
5ICFN EnCTION _ jmprovancnr I'eiyIt
INSPECTION FEE (Required if photO"hy nut provided)
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S90.00 OR Photo will be provided
TOTAL FEE .00
PERMIT ISSUED Sy: Li
EE RECEIVED BY: C �
RELEASED STAMP:
x PAID STAMP: '
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