BOTH-000032-2016 (Void) DXL Mens Outlet Office Use Only
Town of Queensbury Building &Code 2016 Received:
SIGN PERMIT APPLICATION Tax Map ID:
Permit No.: t4 'GCOU-3 1(0
Permit Fee: $
Date t I tj r(A Applicant �raT2 t .-)
Tax Map 10 ?8 b 1 — / —/,5 Address A e C ol L v
Zoning C,a cln�u�c`�'r�-du �I's
- ,Property Owner L&A K..C3t.2-Or/, U l L4-s ,LLC Contractor/Agent-
Address 50 Y-C 6 U-t h F IOorAddress C a ;,%L -
A I rm-ri v N Y 1 Z_z-0-1. ' - < 0 0,�. i a_ 6 R
Phone (I�2 -1+1 1 Phone 3711 3-r/
Contact Person for Sign Code Compliance: ss 0Azv-rij Day Phone: 177-112; E ,-
Building Street Address: CQS Coio""zit- kie•
Site Plan,Variance,or Subdivision Approvals
Location of proposed installation y y a ,-, .40
o
Business ComplexlPiaza/Mall name N
Business name 1>k �, t_�e—r— CV a
Type of Sign proposed f}t t 5, , M ° o
if sign is to be illuminated,Indicate f internal _external _Incandescent _neon other
Do signs currently exist on property? es _No(if yes,list all existing signage)
Change of wordkopy From to °
Sign Wording ICopy
Sign Size Length x Width Total sq.ft. V o
Sign Height(freestanding) m N
Color&Material to be used Z) ,o
7 0 u� T
This application creates a change in the New 0 M
following existing site conditions(fill in all Change in number of signs from to c � c
m N
applicable spaces). Change in setback for sign from to g
00 — ,U
Change in size from to
Change in height of sign from to
Declaration: To the best of-my'knovllY6ve, the statements contained in the application, together with the plans and specifications
submitted,are a true and complete statement of all proposed work to be done on the described premises and that all provisions of the
Zoning Ordinance,and all other laws pertaining to the proposed work shall be complied with,whether specified or noted,and that such
work is authorized by the owner. ++
APPLICANT-PRINT NAME S' Ti A z c 0 II
APPLICANT-SIGNATURE: Al Date: ��L► I w
Declaration: I hereby authorize the applicant to place a sign on my property or building:
OWNER-PRINT NAME: $\1� Lulls &"V-V� O Ut,-t s ,
'rry
' I z5 zoo
OWNER-SIGNATURE: Date:
Town of Queensbury Building&Codes Sign Permit Application 518-761�8255
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