P - 84232Planning Division PERMANENT SIGN Perm;t No.: ��� � ti ��i�
763-572-3595 PERMIT APPLICATION
763-571-1287 fax 7� Re�y�� Y. .,'_,��` �', �.� -
CITY O� F IDLEY
� E c.�vE 1�-i i Dat� c d:
DATE: � "1 A LICANT E-MAILi DDRESS:
INSTALLATION ADDRESS: _� � I S�� \9 P- T� t c��/ ��N. S�S�3� SU[TE
THIS APPLICANT IS: ❑ PROPERTY OWNER ❑ TENANT ❑ SIGN ERECTOR
NAME: �• � � {F.i �U� S[GNATURE:
PROPERTY OWNER ADDRESS. �\�f I� ' S '�
CITY ,�� ,1D l�'P�r C� STATE �L. ZIP �,.%L�Up
PHONE: �hI - 3 � J�W CEL'L PHONE: FAX:
TENANT NAME: ��
ADDRESS: � i E �� SUITE
CITY STATE Z[P
PHONE: CELL PHONE: FAX:
SIGN ERECTOR NAME: N �� �� S ��� �� l.'�'�� � L�
ADDRESS: �' � �'
(Requires City License) � � � �' S TE
CITY STA"iF/�'� ZIP �
PHONE: � � CELL PHONE: FAX: /� �s����/
CITY LICENSE: EXPIRAT[ON DATE: APRIL 30
NOTE: Per City Code Sect 214.19, a City license must be obtained by every person engaging in sign erection, construction and repair, including billboazd and electrical
si ns. Ci license fee is $35.00.
SIGN MESSAGE: �! 7 �� ` -"—i� ��/���iG�. C' �',N T%Z /1 L
� ZONING: C_� LENGTH: �✓ � r6 � � S � HEIGHT: � � � 3 ` l0 �Y = TOTAL SQ FOOTAGE: � �-T . !" �
FOR MULTIPLE WALL SIGNS (provide additional information):
ELEVATION: LENGTH: HEIGHT: = TOTAL SQ. FOOTAGE:
ELEVATION: LENGTH: HEIGHT: = TOTAL SQ. FOOTAGE:
CONSTRUCTED OF:
ILLUMINATED 7 YES IF YES, AN ELECTRICAL PERMIT IS REQUIRED TO WIRE SIGN
ESTIMATED VALUE:
❑ Wall -Ete�at�on �irect;on Len th of wall: Allowable s i:
❑ Wall-E�e�at;on D;rect;on Len th of wall: Allowable s ft:
❑ Wall - Elevation Direction Len th of wall: Allowable s ft:
' P lon Setback from ro e line: From drivewa : Off round: /� . a � -�
❑ Monument Setback from ro ert line: From drivewa :
❑ Roof In lieu of lon si n:
NOTES: �C'1'c�a�_c' /=l�t:.�,S' Q/a/ �°C 1 LiC/,S�-1^�({ P�/�a":J ���c�:v�
�
FEE SCHEDULE SIGN PERMIT FEE: ' $3�0.00
IF NOT ILLUMINATED, ADD 5.00 STATE SURCHARGE:
TOTAL:
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
The undersigned herby makes application for a permit for the wark herein specified, agreeing to do all wark in strict accordance with the City of
Fridley ordinances and rulings of the Planning Division and hereby declare s that all the facts and representations stated in this application are true and
correct. -
v��1�1� ��i�✓(I<</?� DATE 3�
SIGNATURE OF AP .�1NT� � PRINT NAME «/ ��
�
APPROVED BY � > : � ;� � Y �/"' I � ' PRINT NAME �`���9 � � , , �,�Y� %�- � DATE�� �� �I � � � �,
WSPECTION: ❑ FINAL � f •
PLEASE NOTE' SEPARA PERMIT IS REQUIRED FOR ELECTI2ICAL RK
CITY OF FRIDLEI' - PLA\\ItiG DEPARTMENT
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
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