2004-822 Body Relief TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040822 Application Number: A20040822
Tax Map No: 523400-296-013-0001-018-000-0000
Permission is hereby granted to: BODY RF,T,TFF
For property located at: 959 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 die NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: GUIDO PASSARELLI
465 LAKE Ave Sign
Total Value
LAKE LUZERNE, NY 12846-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-822 BODY RELIEF
18.2 SQ FT WALL SIGN(moving to new location, change of copy, and 9.2 sq. ft. larger sign than previous)
Location:. Store Win the Mount Royal Plaza
$18.00 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 eeb Th r d Wober 21, 2004
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OFQUEENSBURY Fee Paid:
742 Bay Road, Queensbury, IVY 12804 Approved By:
(518) 761-8256 Permit #: -
SIGN PERMIT APPLICATION c�� V
THE FOLLOWING INFORMATION IS REQUIRED:
1. Detailed drawing or photo of sign.
2. Plot plan of location of sign.
3. Written consent of the owner of the building or land.
OWNER OF PROPERTY 1yo02., � �
ADDRESS _96-`l TEL.
NAME OF APPLICANT _��,u.�5 ab��✓
ADDRESS 7?T,' `l ����Pi �� loZ Dy TEL. �9a2'G�!`1Cy
BUSINESS NAME IF DIFFERENT:
TYPE AND LOCATION
Check What Applies: Existing Permanent Projecting Sign
Temporary Nan-conforming Existing
Free-Standing Wall __ New �04C
Location: Tax Map Number cs- L
Address
Proposed Setbacks from Property Line (front) (side)
If sign is to be illuminated, please check appropriate box:
Internal (kf, External ( ) , Incadescent ( ) , Neon ( ) , Other
Size of Sign: Width �. ft. Length ft. S` G
Total Square Footage:
Sign Copy:
Color and Material To Be Used:
Signature:
Circle-One: A licant, owners-"contractor or agent
I HEREBY AUTHORIZE APPLICANT TO PLACE A SIGN ON MY PROPERTY OR BUILDING.
Signature of Property Owner:
1
ORIGINAL-Office Copy COPY-Applicant
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