P - 41827Planning PERMANENT SIGN
Division PERMIT APPLICATION
763-572-3595 CITY OF FRIDLEY
763-571-1287 fax Errec� ve�- -zo�o
DATE: � `� APPLIC��1T -NjAIL ADDRESS: � �(/%'
INSTALLATiON ADDRESS: �� /
THIS APPLICANT IS: ❑ PROPERTY OWNF,R ❑ TEN
PROPERTY OWNER
rENAtvT
ADDRES
CITY
NAME:
ADDRE
CITY_
PHONE:
�SIGN ERL'•CTOR
����'�' ��' ��� �_'_��NATUR
� / � JT /" STATE ! /� 4"
�—� -�� �
� �'�. PHONE: g
?%1 l!1!I l !/_' V� L��si
Permit No.: L� � 4�` ����'
Received By: ��
��i��ties�c� � Q � � � � �
G;
STATE ZIP `) �
CELL PHONG: FAX:
NAME: n/; J � �I � �
SIGN ERECTOR •
(Reqttires City License) ADDRESS: � � � � �i� � SUfTE
CITY STATE � 7..1P �
I'HONE: I� � EL p�' IONG: FAX:
CITY LICENSE: EXPIRAT[ON DATF.: APRIL 30,
NOTE: Per City Code S�ct 214.19, a City license must be obtained by every person engaging in sign erection, �onstruction and repair, inchiding billboard and electrical
si ns. Ci license fee is $35.
SIGNMESSAGE: �i TC � .,l'�
ZONING: l� �" �'� LENGTH: G C _HEIGHT: � = TOTAL SQ FOOTAGE: ��'�
/�, ��
CONSTRUCTED OF: IGT f�L (l1,G'�I Y/�S� � C t�,'
ILLUMINATED: �NO ❑ YES IF YES, AN ELECTRICAL PERMIT IS REQUIRED TO WIRE SIGN
ESTIMATED VALUE: 't" �t� �
Wall Len th of wall: Allowable s ft: ��'1
❑ P lon Setback fi-om ro ert ine: From drivewa : Off round:
❑ Monument Setback from ro ert line: From drivewa :
❑ Roof In lieu of lon sign:
NOTES: , i
rEESCHEDULE
.
SIGN P�RMIT FEE:
IF NOT ILLUMINATED. ADD $5.00 STATE SUKCHARGE:
TOTAL:
$350.00
TH[S IS AN APPLICATION �OR A PERMIT-NOT VALID UNTIL PROCESSF.,D
The undersigned herby makes application for a permit f r the work herein specified, a;reein� to do all work in strict accordance with the City of
Fridley ordinances and nilings of the Pla ing Divisi a hereby declare s that all the tacts and representations stated in this application are tnie and
correct. 1
SIGNATURE OF AI�I�C�g1�'i' � PRINT NAME_/��l/G /l�i��;!��/ 1�ATF �✓��L
APPROVED BY �./�'
INSPECTION: ❑ FINAL
PRINT N
1'�: S�;YAfZf1T�B'ERMIT tS RBQUiRED FOR ELEC'
CITY OF FRIDL�Y - PLANNiNG DCPARTMGNT
6431 UNIVERSITY AVENUF, NE
FRIDLEY, MN 55432
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