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'No.2485 'P. 1
PLANNINL ,,,, ZONING
DEPARTMENT
12 N. Center PO
B.
X 280)
Rexburg, 83440
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Application for Sign ]Permit
Applicant Information Temporary Signage
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Date ofApplication: - - 0
permit Number:
Owner Name: 21A 0 k-,
Site Addresis-,
Mailing Address: C'ty/State/ZiPTe2ephonoTelephone.*� 83yy0
3 Mobile,7— � 3
Contractor Information .-. �314��
Contractor's Name:
Contractor's Address:
City/StateJZip
Contractor'sIfTelephone
Mobile:
Sign Information
Sign Descriptions:
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For a Slam hrmdt it 1A
2
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� that you have the fallowing informdan;
nO new:.aid-- � -
�■ �icruuQngrawings
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DraWn
toscgle
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lllmiar�e0,�....
And complete construction materials
Footing� if app]icabl+e
Engineer stamped ifreq1uired
OMR'y
FRSE
-SIAMMG SIGN
a Plot Plan to scale ehowing;
❑ a) Building Location
❑ b) Loi size
❑ c) New sign 10-cafiun
� }Dimensions to sign from P rop��,, lines
} Parking dot entrances
Distance of sign ficin right of way .� .� ;
0 9) Exi5fing SIq igne location � a��g C
ble
am on MW SM
Y -M XUARY
�ALL RANMU & 3IGNS
d a) Sq, footage of wall {sign on}
4 h} ExJ�t�ng s#gns �
A C} Now sign & area
D d} Location of sign an wall
U e) 1:5 sign lighted? Yep (M,usl meet stWe electrical code)
(Wim mint be in legal zo,rEfor ligh ling and tyPe)
Ll BIP LIgh't8,6I Yea �
� uv� meex state elec#icul code) (sign mush be in legal zone fir ligl�ang and type)
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Signature of Applicant;
Note. nitmm"a for 1i
-01jon perp
Orly (the ieo s'g� Pmiut form rnuat be slgfied by city oMcisls before pIgn is approved)