A. Type of Sign Permit
Type: For Office Use Only
Sign A/P # ________________
Permanent Sign Sign Tag# _________________
Electrical A/P# ____________
Limited Duration Sign Sign Permit Fee: $20.00
Date: _____________________
B. Location of Sign
Address: _____________________________________________________________________
Lot _________________________ Block ______________________________________ Parcel ____________________
If a limited duration sign is located within the public right-of-way, provide block number of street
C. Applicant Information
Name of Applicant _______________________________________________________ Phone#______________________
Address _________________________________________ City _______________________State_____ Zip __________
Contact Person ___________________________________________________________ Phone# ____________________
Sign Installer _______________________________________________________ License # ________________________
Address _________________________________________________________________ Phone# ____________________
City ____________________________________________________________ State ______ Zip Code _______________
D. Permanent Sign Information
On Building Wall Freestanding Canopy
Illuminated Non-illuminated
Sign message _________________________________________________________________________________________
Dimensions: Sign Area _________________square feet
Length________ft_____inches Width__________ft_____inches Height__________ft_____inches
E. Limited Duration Sign Information
LOCATION: TIME OF DISPLAY:
Public Right-of-Way Weekends Only
or or
Private Property Other Time Period
Sign Message _________________________________________________________________________________________
Sign Dimensions: _____________ Length _____________ Width ______________ Height
F. To Be Read by the Applicant
Any information that the applicant has set forth in this application that is false or misleading may result in the rejection of this application. A condition for the issuance of this permit is that the proposed construction will comply at all times with the plans as approved by all applicable government agencies. I hereby declare and affirm, under the penalty of perjury, that all matters and facts set forth in this sign permit application are true and correct to the best of my knowledge, information and belief.
_____________________________________________________________________________________________________
Applicant’s Signature Date
AUTHORIZED AGENT AFFIDAVIT:
I hereby declare and affirm, under the penalty of perjury, that:
1. I am duly authorized to make this permit application on behalf of:
_____________________________________________________________________________________________________
Print Property Owner’s Name Phone
2. The work proposed by this sign permit application is authorized by the property owner, &
3. All matters and facts set forth in this Affidavit are true and correct to the best of my knowledge, information and belief.
_____________________________________________________________________________________________________
Original Authorized Agent’s Signature Date Print Name
APPROVED DENIED
_____________________________________________________________________________________________________
ZONING INSPECTOR’S SIGNATURE DATE