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Applicant Information
Date of Application:
Owner Name: r
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Permit Application
City of Rexburg
Phone: 208.359.3020
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 Signage
)ermit Number:
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Site Address: 305 V P
Mailing Address: /� R � �/ krA -- !` City/State/Zip ���l,� �� l � ���1q
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Telephone: D - !i 19 - U 5 � Mobile: — 1 1 - �
Contractor Information
Contractor's Name:
Contractor's Address: F i -5 4 KI city/state /z r- _fL�L ; �qy b
Contractor's Telephone: 9� 33 2 ' Mobile: 5 -
Sign Information
Sign area sa. ft: Sign Height (from ground): '"
Sign Descriptions:
DEC 2 1. 2007
For a Sign Permit it is mandatory that you have the following information: 1
2 sets of elevation drawings of a sign & (plot plats if applicable i CITY OF REXBURG
Drawn to scale with dimensions
and complete construction materials
Footings if applicable ; e
Engineer stamped if r e
FREE STANDING SIGN ,,*ALL SI S ? � Z - 3 -9 >< G L ft}
❑ Plot Plan to scale showing: ✓ r.9 S ootage of wall (sign on) ,•"
❑ a) Building location ❑ lusting signs & area jr 3
• 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 -one for lighting and type)
❑ 0 Distance of sign from right of way
g) Existing Signs location & area
h) Is sign Lighted? Yes (must meet state elec 'cal de) (sign must be in legal done for lighting and type)
Fee: $100.00 - $75.00 refundable at t' a of `al inspection and photo of completed sign..
Signature of Applicant:
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Note: This document is for appli purposes only (the legal sign permit form must be signed by city officials before sign is approved)
See Sign rdinance (no. 908) at www.rexb=.org for regulation information.
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CLAIM FORM
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REXI3URG
VENDOR#
America's Family Community
VENDOR NAME
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DATE
i 12- 12-6
2nd LINE NAME
FED ID or SS# tib
ADDRESS
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TELEPHONE
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CITY, STATE, ZIP
1099 CODE:
Normal 1099 Rent
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DESCRIPTION
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JAMOUNT JAPPROWE
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