2004-124 Ellies Cafe l
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040124 Application Number: A20040124
Tax Map No: 523400-295-008-0001-002-000-0000
Permission is hereby granted to: RT,TJRS C;AFF,
For property located at: 1161 STATE ROUTE 9
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: MITCHELL A COHEN
PO BOX 21 Sign
Total Value
LAKE GEORGE, NY 12845
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2004-124 ELLIE'S CAFE (CHANGE OF COPY)
48 SQ FT FREE STANDING SIGN
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES:
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Thursday,April 08, 2004
SIGNED BY \ for the Town of Queensbury.
Director of Building& e orcement
_1
TOWN OF QUEENSBURY Fee Paid:
742 Bay Road, Queensbury, IVY 12804 Approved By:
(518) 761-8256 Permit #: d �a
SIGN PERMIT APPLICATION
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THE FOLLOWING INFORMATION IS REQUIRED:
MAR 2 S 2004
1. Detailed drawing or photo of sign. TOWN OF CUEENSBUR
2. Plot plan of location of sign. BUILDING��i-
3. Written consent of the owner o/ff the building or land. CODE-
OWNER
OF PROPERTY _ t�FLe� l 4- ��G'tr�6'7 : 175 -
to
ADDRESS 7 &ti ��i LAIC l��A,►'tgO, LP /2YgSTEL. f7to/-D2CS
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NAME OF APPLICANT
ADDRESS LL TEL.
BUSINESS NAME IF DIFFERENT: IJ 111
TYPE AND LOCATION Check What Applies: Existing Permanent =/ Projecting Sign
Temporary Nan-conforming Existing
Free-Standing Wall __ New
Location: Tax Map Number
Address ii-59
Proposed Setbacks from Property Line (front) _ (side) _
If sign is to be illuminated, please check appropriate box:
Internal ( ) , External (/Incadescent ( ) , Neon ( ) , Other ( )
Size of Sign: Width ft. Length — ft.
Total Square Footage.Sign Copy:
Color and Material To Be Used: r/ Zi �'r�tX6'_'4tbP'e
Signature:
Circle One: Applicant, owne contractor or agent.
I HEREBY AUTHORIZE APPLICANT TO PLA E SIGN ON MY PROPERTY OR BUILDING.
Signature of Property Owner:
ORIGINAL-Office Copy COPY-Applicant
MAILING: SHOWROOM:
P.O. Sox 332 • Glens Falls,NY 12801 52 Main Street • Queensbury,NY 12804
ph. 518-792-4009 fx. 51.8-792- 476 I
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