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Sign Permit Application
City of Rexburg
12 North Center Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3022
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C I T Y OF
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America's Family Community
Fixed Sigrlage
Applicant Information
Owner Name: 1 Ae 6ft'
Site Address: ' W le `1r !" 4 - `~
Mailing Address: c , - ty /State /Zip: � (t) v? "G �f
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Telephone: `7 tiZ ' Mobile:
Contractor Information
Contractor's Name: S 11A V%
Contractor's Address: 2 q "q e S i✓ City /State /Zip:
Contractor's Telephone: 1 3 Z ` ( `� Z `{ Mobile: ? 7 1, 0
Electrical /Specialty Contractor Information (For powered or lighted signs)
Contractor's Name: � ce -it L-t kA 6- C e Ca r, Contractor's License Number: 554-A
Contractors Address:
City /State /Zip:
Contractor's Telephone: — 7 1 G — i Z- '-( J Mobile:
Contractor's Signature:
Sign Information
Sign area sq. ft:
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Height (from ground):
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Sign Descriptions:
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For a Sign Permit it is mandatory that you have the following information:
2 sets of elevation drawings of a sign & (blot -p lats ifa0.plicable
Drawn to scale with dimensions and complete construction materials
Footings if applicable
Engineer stamped if required
FREE STANDING SIGN WALL SIGNS d 2 6 2008
❑ Plot Plan to scale showing: z a) Sq. footage of wall (sign )
❑ a) Building location ❑ b) Existing signs & area
❑ b) Lot size c� c) New sign & area
❑ c) New sign location 9Ld) Location of sign on wall
• d) Dimensions to sign from property lines ) e) Is sign lighted? Yes (must meet state electrica co
• e) Parking lot entrances (sign must be in legal Zone for Iigbft and Vie)
❑ 0 Distance of sign from right of way
❑ g) Existing Signs location & area
h) Is sign Lighted? Yes (must meet state electrical code) (sign must be in legal Zone for lighting and Vie)
Fee: $100.00* - $75.00 refundable at time of final inspection and photo of completed sign.
*An extra $40.00 charge will be applied to any powered or lighted sign.
Signature of Applicant: 1 Date
Note: This document is for application purposes only (the legal sign permit form must be signed by city officials before sign is approved)
See Sign Ordinance (no. 908) at www.rexburg.org for regulation information.
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CLAIM FORM
VENDOR #
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R-EXBUR-G
AMERJCNS FAMILY COMMUNITY
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ADDRESS
CITY, STATE, ZIP
DATE
FED ID or SS#
TELEPHONE . 3 <O0 - &, F
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