P - 84231Planning Division PERMANENT SIGN
763-572-3595 PERMIT APPLICATION
763-571-1287 fax CITY OF FRIDLEY
trEr.ci�iv� �-i-i i
DATE�: %�1 � APPLICANT f:-MAIL ADDRBSS:
INS'iALLATION ADDRESS: _ ���_� " ' _ � _�_��L'
THIS APPLICANT IS: D PROPERTY OWNEft ❑'i'ENAN'f ❑ S1GN ERF.CTOR
PROPERTY OWNER
TENANT
CITY V � �l.J VC�
PHO '� ��!A-�
NAME:
ADDRESS: ��j '4.Q __�
C[TY
CELI. PHONE:
P���r No�
Received By:
Date Re�'d:
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SIGNA'CUKI�:.��-s�
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PHONC: CI:LL PHONE:: FAX:
S[C;N ERGCTOR NAMF.: S��/ ��•rva�� T/•! i S S iE,�/ s
(Requires City License) AtIE�RESS: � g�S Li/^� ��� C ��- St1ITE
CCTY /�Z�P`S / STATE 1�� ZfP � `-� �Ij�
PHONC: �" �O2 '� ��� �y�� CELL PHOIYE: llJ�� � ��°'�' '��I FA7C: C�-z - S �'� —�y� I
CfTY LICENSE: EXPIRA7(ON I7A'FE: APR[L 30.
�.���.
SIGN MGSSAGE: � r1T"}1:1W rac._ `7 I I�� tir b�fi l'l i2� Nr� �ll•P�;S , S�� ✓IC:� • j�/Z/3 l'C¢S •!3A 17�/Z / J
/ ,� L
ZONING: _.�.._LENGTH: i_ �P � HFIGNT: _ � � �I� _�="F07'AL SQ FOOTAGF.: � � � � � � �"1� { S
FOR MULTIPLF WALL SIGNS (provide additional inforn7ation): �re'��"
� � � � �-ioh
ELEVATION: �- LENGTH: �I � (p �� NFIGH7': .� � /L _ ='1'O"1'AL SQ. h'OOTAGEi:
ELEVA7IUN: � 1.F:NGTH: � � � �� HEIGHT: ^� � � ��� �� — TOTAL SQ. HOOTAGF,: .l___ f , 7 . 53 �'
CONS7RUC1'ED OF; l�r-v. w� � �` f�-Y �- � �- �����/�
ILLUNi1tVATED: l7 NO �i YES IF YFS, AN ELECTRICAL PERMIT IS REQUIRf D T0 WIRE SIGN �`��"�
ESTIMATED VALUE: __
WBIL - Elevation Direction i 3' Len th of watl: ' Allowable s ft:
� Wall �� Elevation Direction i 3_' S Len th of wall: �� Allowable s ft:
❑ Wall Elev�iion �ireccion __ Length of wall: Allowable s ft:
❑ Monument
� Roof
: from property line: _ From drivf
; from nroaertv line: From drivi
In lieu of pylon si
NOTES: �eQC.ra c i-"�T— ��rF>cL �� FG �Z S� yv"-a — -_.
FEESCHEDULE
�S'',G,S� FUY E e.l�
s-. i � tr� -
Off
SIGN PtRMIT PGG: $350.00
IP A'OT ILLUMINA'fED, ADll 5.00 STA`I F SURCHARGE:
T'OTAL:
THIS 1S AN AFPLICATIOV FOR A PERht[T-Np"f VAL.ID LNTIL PROC'ISSSF.[)
Thc undersigned herby makes application for a�emiit for the work herein specified, agreeing �o do all �vork in strict accordance with the City of
Fridley ordinances and rulings of d�e Planniii�..B+d � n and hereby declare s that all the facts and representations stated in this application are true and
°� n � �^j /
SIGNATURE OF A ` r, C� � . PR1N"I' NAME `�F'111��j`C( J✓I f"�i`� DAT�I �y/�
V ., _—
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� � ��� k'RiNTNAME � 't� � ��
APPROVED BY � ', �. _ _ �.,_'� �ATE �J �I , .
INSI'ECTION: ❑ FINAL i , __ '� i ' J' � �
C1TY QF FRIDLEY - PLANNING DEPARTMF.NT
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