HomeMy WebLinkAboutAPPLICATION & RECEIPTS - 12-00549 - 109 S Center St - Andersen House - SignCITY OF
Owner Nafne;
Site Address:
Contractor's Address:
Contractor's Phone:
Contractor's Phone:
Sign Permit Applicqlion
City of Rexburg
Phone: 208.359.3020
Fox: 208.359.3022
*m
Mobile:
Mobile:
Date:
35N. IsrE,
Rexbgrg, lD 83440 .i J,:lxlt
REXBURG
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Ame ica's Fa mily Communi ty
C4 ID
MailingAddress: #. !!jg *. Zott N. iity/st.t"/zip,
Telephone:Mobile:
Contractor Information
Contractor's Name:
Fixed signage -Tv{,
Anolr'rstyr \\tru\e ,
City/State/Zip:
ElectricaUspecialty contractor Information (For powered or tighted signs)
Contractor lnformation
contractor's Name: l,.i/A No r' lpf i-[ f r' ,ttl
Contractor'sAddress: t O ciVstate/zip:
Contractorrs Signature:
Sign Information
Sign Area sq. ft:
Sign Description:
For a Sisn Permit it is mandatorv that you have the following information:
1. 2 Sets of elevation drawings of a sign & (plot plats if apolicobtel
2. Drawn to scale with dimensions and complete construction materials
3. Footings if applicable
4. Engineer stamped if required
FREE STANDING SIGN
tr PLOT PLAN TO SCALE SHOWING
trA) BUTLDtNG LOCATTON
tr B) LOT SrzE
trc)NEWS|GN LOCAION
:- Ft t- ;] ft sign Height (rrom ground):tt (ir *in bet
WALL SIGNS
tr A)Sa. FOOTAGE OF WALL (S/GN
n B) EXISING stcNs & AREA
tr C) NEW SIGN & AREA
E D) LocATtoN oF stGN oN WALL
tiruu'
d / tta " a{i F-]t.'rr, 1".r.-.(",( { .4"* t&-. *- -
ED)DIMENSIONSTOSIGNFROMPROPERTYLINES tr E) TSS|GNL|GHTED?yES(mustmeetstoteetectricol code) YIA \ /'tlO tE E) PARKING LOT ENTRANCES (sign must be in lego! zone Jor tighting and type) ' ' ' 0 I- ,gqVltr F) DrsrANcE oF stGN FRoM RIGHT oF wAy )fi $
EG) EXISTING SIGNS LOCATION & AREA '\
tr H) lS SIGN LIGHTED? YES (must meet state electricol code) (sign must be in legol zone for tighting ond type)Fee: $100* - 575.00 refundable at time of final inspection and photo of completed sign.*An extra 565.00 charge will be applied to any powered or lighted sign.
Signature of Applicant:
Note: This document is for a
For Office Use Only:
Darc: ll0(/, +1 fui?
proposes only (the legal sign permit form must be signed by city officials before sign is approved)
n Ordinance 1027 at www.rexburg.ors for regulation information.
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DEc o 4 zotz
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Receiptcodes:(Regular)tlPZ: $25.00 [ ] PZSD:$75.00 (ForElectricalAdd) t I ELEC:$4o"0+
CLAIM FORM
VENDOR #
VENDOR NAME
2nd LINE NAME
ADDRESS
CITY, STATE, ZIP
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4I;tI'<5 I t\ 12.€t t 'tDATE
DH APPROVAL
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l?r(rv,+ ,ID S3'i112- CC APPROVAL
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cIl'Y Oi.
REXBTIRG
A me ri ca\ Family Co*tm unity
DESGRIPTION ACCT#ACCT DESCRIPTION AMOUNT
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CLAIMANT OR HIS AGENT SIGN HERE
Receipt Number:140s4
35 North lst East/ Rexburg, tD. Sa440
Phone (208) 359-3020 / Fax (208) 359_3022
RPRruG1049 Sign Deposit
RPRru(Bl049 Sign permit
$ 100.00
genpmtneceipts
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