HomeMy WebLinkAboutAPPLICATION - 04-00418 - Madison Clinic - SignCITY OF G
P.O. Box ox 280 280
Rexburg, Idaho 83440
STATE OF IDAHO (208) 359 -3020
APPLICATION F r-r-' -"'V -r Fax (208) 359 -3022
FIXED sI 04
Date of Application // /t'�� Sign 1 Sign Madison Clinic
Owner Name
Site Address: 0 fay T 1 b)
Mailing Address:
City /State /Zip:
Telephon Mobile:
Contractor's Name:
Contractor's Address: ka Q goo o/
Contractor's Telephone: wen Mobile:
Sign area sq. ft &9 Sign Height (from ground)
Sign Descriptions:
0// Ohm
For a Sian Permit it is' mandatory that you have the following information:
2 sets of elevation drawings of si n & (plot laps if aDDlicable)
Drawn to a scale with dimensions
And complete construction materials
Footings if applicable
Engineer stamped if required
FREE STANDING SIGN WALL SIGNS
❑ PLOT PLAN TO SCALE SHOWING ❑ A) SQ. FOOTAGE OF WALL (SIGN oN)
❑ A) BUILDING LOCATION ❑ B) EXISTING SIGNS & AREA
❑ B) LOT SIZE ❑ C) NEW SIGN & AREA
❑ C) NEW SIGN LOCATION ❑ D) LOCATION OF SIGN ON WALL
❑ D) DIMENSIONS TO SIGN FROM PROPERTY LINES ❑ E) IS SIGN LIGHTED? YES (must meet state electrical code)
❑ E) PARKING LOT ENTRANCES (sign must be in legal zone for lighting and type)
❑ F) DISTANCE OF SIGN FROM RIGHT OF WAY
❑ G) EXISTING SIGNS LOCATION & AREA
❑ R) IS SIGN LIGHTED? YES (must meetstate electrical code) (sign must be in legal zone for lighting and type)
Fee: $100.00 - $75.00 refundable at time of final inspection and photo of completed sign.
Signature of Applicant:
Note: This document is for application purposes only (the legal sign permit form must be signed by city officials before sign is approved)
A.
O
U
STATE OF IDAHO
OFFICIAL SIGN PERMIT APPROVAL FORM
FIXED SIGNAGE
CITY OF REXBURG
P.O. Box 280
Rexburg, Idaho 83440
(208) 359 -3020
Fax (208) 359 -3022
DATE: I I.3Q -
TIME: VW ISIGN PERMIT # S - ppQ �
OWNER NAME:
t l C TOOM Ne: kow
SITE ADDRESS
2A0 C W N
CITY /STATE /ZIP:
TELEPHONE
20$ -�S6 QQ
MOBILE
CONTRACTOR'S NAME
AGE -Q q c0
CONTRACTOR'S ADDRESS
TELEPHONE 7 !;A_ S
MOBILE
SIGN APPROVAL PROCESS COMPLETE OR PRO LEM AREAS
SIGN REVIEW TO MEET
CURRENT SIGN CODE
initials /< 44
APPROVED
refer to notes for reason('s) for denial
DENIED
ENGINEER REVIEW TO MEET
CURRENT CITY BLDG CODE
Initials
APPROVED
refer to notes for reason('s) for denial
DENIED
PLANNING AND ZONING ADMINISTRATOR Initials
OR PLANNING & ZONING REVIEW refer to notes for reason('s) for denial
APPROVED
DENIED
CONDITIONAL USE PERM_ IT
REQUIRED
Y
if yes are all conditions met?
APPROVED OR N/A
O
r efer to meeting notes attached
DENIED
red marks indicate areas needing correction before sign can be approved
number marks
notes: 88-P S MAI OUT 0 F A 1GIfr o!~ W ca>VAI-L L `L Y `t GB PA, ! 161
Signature Of Approval By City: '
signature to be signed If
by planning & zoning administrator
or the city clerk after 4 categories app�rZd
At
11
' 61
madisonclinic 11/16/2004 10:49:26 AM
Scale: 1:18.53
153.074 Length: 96.048 in
MAE3I�ON CLINIC
i
DENTISTRY &ORAL HEALTH
DR. LAYN� HACKING, D.M.D.
EYE CARE 8c OPTICAL
DR. DAWN HEINER, O.D.
DR. SALLY HA�KING, O.D.
MEDICINE DERMATOLOGY
DR. CRAM HEIINER, M.D.
3 ,,