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Planning PERMANENT SIGN Permit No.:�b���'"Y!"�3
Division PERMIT APPLICATION Received By:_���
763-572-3595 CITY OF FRIDLEY � � �d1�
i y �
763-571-1287 fax � �E�
EFFECTNE 1-1-08
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DATE: , '� � APPLICANT E-MAIL ADDRESS: I i �= Y�, � �. � i �< ! � �'� � �;� ',�,/� �- � � - r' ��
� � � ..� � � � �
INSTALLATION ADDRESS: / �� �7 � �� <, � ,'i, < <.� � ; �( . �� �-t (, SUITE
TH[S APPLICANT fS: ❑ PROPERTY OWNER ❑ TENANT �'S[GN ERECTOR
NAME: ` , r � �, �� � SIGNATURE:
PROPERTY OWNER AppRESS: 7 > � � � �'�<� - ��- % ,. �' � �
�'�,, ;i
CITY r� �� �-C � STATE �', i�. � ZIP
PHONE: CELL PHONE: FAX:
I'ENANT NAME:
ADDRESS: SUI?E
CITY STATE ZIP
PHONE: CELL PHONE: FAX:
1 ' �
SIGNERtiCTOR NAME: �r��� ;'-� r-, � �,,�,�. �,�i- �� l>' �_ � �> .
; ��
(Requires City License) ADDRESS: i,/ ? C7 l_- �� � �-i�,� � �r<-, � � � �-;r, ; �� � SUITF. �
CITY � ���ol�� STATE ��"%%�� � ZIP ���,� %
PHONE: ' �% � : � ' "i � � �'� ' ' ' CELI. PHONE: I'AX: = � � � � � � � ' `� �'�� 5' %
CI'TY L[CENSE: EXPIRATION 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 billboard and electrical
si ns. Ci license fee is $35.00.
SIGN MESSAGE: F ' : ', '
ZONING: LENGTH: HEIGHT: = TOTAL SQ FOOTAGE: 1�.,< ��
CONSTRUCTED OF: - � � �' �� �i �� ' !
ILLUM[NATED: ❑ NO fl, �'ES IF YES, AN ELECTRICAL PERMIT IS REQUIRED TO WIRE SIGN
ESTIMATED VALUE: �� ' `'� �� `�� � '�-� �
Wall Len th of walL• Allowable s ft: . 1 �
❑ lon Setback from ro e line: From drivewa : Off round:
❑ Monument Setback from ro e line: From drivewa :
❑ Roof In lieu of lon si n:
NOTES:
FEE SCHEDULE SIGN PE[tM[T FEE: $350.00
IF NOT ILLUMINATED, ADD .50 STA"fE SURCHARGE:
TOTAC,: ''•- , �
TI IIS IS AN APPLICA'I'ION FOR A PIiRMIT-NOT VAI.ID UNTII. PROCfiSSED
t'he undersigned herby makes application for a permit for the work herein specitied, agrecing to do all work in strict accordance with the City of
I�ridley ordinances and rulings of the Planning Division and hereby�dedare s that all the fac[s and representations stated in this application are true and
correct. , -�
J� v,��i
SIGNATURE OF A PLJ,�A�1T„ �- —'/ � PRINT NAME J='- � � l: �", . DATE�
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APPROVED BY ,. � � �, ;� ( ���'✓ � i� � PRINT NAME `: - �� � � ��'��=.�� ATE _I '���� I �
. � �
INSPECTION. ❑ FINAL I •
PLEAS NOTE: SEPARAT�- ERMIT IS REQU[RED FOR EL,ECTRICAL WORK
CITY OF FRIDLEY - PLANNING DEPARTMENT
6431 UNNERSITY AVENUE NG
FRIDLEY, MN 55432