2004-850 Jacks Discount Warehouse TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040850 Application Number. A20040850
Tax Map No: 523400-296-013-0001-018-000-0000
Permission is hereby granted to: JACK PERNA .
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 the 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 Builders Name/Address Electrical Inspection Agency
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Plans &Specifications
BP 2004-850 Jacks'Discount Warehouse Space ZZ
65 sq. ft. wall sign
$130.00 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 Towtr<of Queens ry;W
iday,November 05,2004
(SIGNED BY �,./��uz~ //";'�F for the Town of Queensbury.
Director of Building 86 Code nforcement
Fee Paid:
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804 Approved By:
Permit #:
(518) 761-8256
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SIGN PERMIT APPCICA'TI'0W.r
FOLLOWING INFORTONCIS2f E D:
THE FO ,,MA,,, I
,,, , , Q�r ,
1. Detailed drawing or photo of sign.
2. Plot plan of location of sign. - }�
3. Written consent of the owner of the building 6_i'l and.91
OWNER OF PROPERTY
ADDRESS �` S' TEL.
NAME OF APPLICANT _J - PC,,
ADDRESS � � ll��' l�lcPC �' 5y� �"� z TEL.
j1 7 7
BUSINESS NAME IF DIFFERENT: tC�� f ,f�c��ul
TYPE AND LOCATION
Check What Applies: Ex-i-gyp^rr:� Perman _ Projecting Sign
Te , j_ Nan- ormi E '•sting _
Free-Standing �_ Wall _ New `
Location: Tax Map Number `_
Address -9 7
Proposed Setbacks from Property Line (front) �/Z 0 (side) 1�pC-)
e( fan
If sign is to be illuminated, please check appropriate box: 1/3
Internal ( j , External ( ) , Incadescent ( ) , Neon ( ) , Other /0
Size of Sign: Width Z% ft. Length _ ft. Ile //--
Total Square Footage: r0�
S*�ayt�r
Si gn Copy:
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Color and Mate r To Be s ,�e �'U f "1 .�_
Signature: 'L -
Circl One: Qjplican.V, owner, contractor or agent.
I HEREBY AUTHORIZE APPLICANT TO PLACE A SIGN ON MY PROPERTY OR BUILDING.
Signature of Property Owner: 4
ORIGINAL-Office Copy COPY-Applicant
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18'
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