BOTH-00089-2016 St. Peters Health Partners Albany Associates in Cardiology Office Use Ono,
Town of Queensbury Building & Codes !
Received�
SIGN PERMIT APPLICATIOs 17016 Tax Niap ID
Permit No 09C 46
i Permit Fee
Date v Applicant — _
Tax Map ID Address
Zoning. !I1 _ :� , ✓( �;y11'� -Gy j
Property Owner ContractorlAgent__�*
Address Address
Phone Phone
Contact Person for Sign Code Compliance: J-''� -' '' ! Day Phone: 'C'
Building Street Address: �_;% .-«,:,����I�; °�..�' �',�.,�ti �,�� ��y �Z u ; a
Site Plan,Variance,or Subdivision Approvals__-.-__.
Location of proposed installation
Business Complex/FlazaiNtall name _
Business name
Type of Sign proposed ----
if sign is to be illuminated. indicate � U i _internal _extern I _'rcandescert _neon _other
Do signs currently exist on property? N Yes _No(if yes, list all existing signage)
Charge cf word;copy From to
Sign bllording Copy
Sign Size Length -7 ` x'ji 2 _ =Total sq. ft.. _
Sign Height(freestanding)
Color&Material to be used
This application creates a change it the I New
following existing site conditions(fill in ail I Change:n number;of signs from to
applicable spaces) Change in setback for sign from to
Change it size from to
Charge it height if sign from to
Declaration_ To 'ha czst c my a e stare;rerts contaired ; the appiicatior. lcgether with the piars arc scec.ficaticr:s
submitted are a tree and :crrpiete staterrert of ail proposed �werk to be ore on the described premises and ;hat ail ~revisions of the
Zoning Ordinance and ail other laws per airirg to the proposed Work snaJ be complied with, whether specified or noted and that such
wcrz is authorized by the owner
APPLICANT-PRINT NAME
APPLICANT-SIGNATURE Date
ar t:c^ ;c, _e ac^' ar; trace a acy- try property cr ~
OWNER-PRINT NAME
i�
OWN ER-SIGNATURE
02/12/2016 11:25 FAX 002
r
TV'',vn of Queeesbury Buildirg & CCGreS Race'red I
SIGN PERMIT APPLICATION I Tax Vap'C —
Pern;i IIC __--
PeM-1 Fee S .
Date ^ _ Applicant
Tax Map 10 !��4PO. SaZ.:7 j-'ty Address
Zoning J,
c
Property Owner gsc,�,cP-L
... c�,�u.5�. contractor gent
Address ��aa Address '
Phone �`5-1 f�.J' b 3� _. _ Phone _ --- —
Contact Person for Sign Code Compliance. �,'�'� `j pay Phone:
Building Street Address -I. !�4:,tr_..F} 1�?,_�:{ ! ;. } !� r ,� •r -
Site Plan,Variance.or Subdivision Approvals
L=wcn cf prcposed irsiallal cn
Busicess ComplexPlaz3 Ma11 rare
Busiress rarre
Tyre or S,gn prcpcsetl -�-;
s v s!c be i,lt.rnira'e: Iedcaia /1 V _ rtt':`a; _8:C3:^a _^cardest8rt _recr --otter
Co signs:urrertly exist 3n prcperyl -Im. es No of 7e; list ail ex:si rig s;g.-age;
Charga cf nord copy _ _i From
Sign Wordarg'Copy
Sign Size L?r.gth .7 x'r'l dth Total sq ft.
Sign;!eignt(freestanding,
_ 4
Cctor 3 Material to be otied
This 3pplicallorcreales3charge'rTe
fd'a%'rlrg.xisdrg;to,;sdit:crs( ;l Ir 3:1 C`arga:r nurni er c ;igr;frorn • ' to—.—
applicable spaces) Charge it setback fpr sign tr,m to---
Charge lr size from --to _..
C^arge'r height of gr'room tc
-a aCCICaI:Cr. :C(je!ier. 7r't^ 'rr .^!tars drC 5CeCf.-3tICr5
a- a'r.e a-d , r C 9 c i' '?"P", :' 'CfC,^:Sew :'Gros Ce j.",rt.� Cr'he.i.93cCC8t:Ora-r;se5 ;rc!,a: 3:1-rc rl 1 f'
Z�",r, arc at a-,i n,-Ar^u cra pro:CCS3J'r1C'<grad 5,.ec'ea it !ctad 3rC t'at st;c"
v+Crc's ar-1rCnZ@a by tre c,',^er
APPLICANT-PRINT NAME
APPLICANT-SIGNATURE '
0YINER PR:N T�IA,H_ 'c L?440
I
y.
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