3735 (A) Mark Plaza TOWN OF QUEENSBURY
TOWN OF. QUEENSBURY k..,34,L-)Lp
WARREN COUNTY, NEW YORK J E P 151915
Application for P M•
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SIGN ERECTIOIJ PERMIT 7�8�9�10`11y12�1�2�3�4�5�
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APPLICATION IS HEREBY MADE to the Building & Zoning Department for
the issuance of a sign permit pursuant to the Town of Queensbury Zoning
Ordinance. The applicant agrees to comply with all applicable laws, or-
dinances and regulations .
FREE STANDING SIGNS must be accompanied by a plan indicating • loca-
tion ( set-back) from property lines. Signs that are to be attached to a
building must be accompanied by a diagram indicating all dimensions.
1. Applicant is mome d�'G.9x/9
(Owner, lessee, agent or builder)
2. Name of owner of premises , �� C(1u `
3. Mailing address of owner a L6.%1.r5
4. SIZE OF SIGN (Width) 4 ft. ( Length) . c�// ft.
Free Standing ( Heigth) c21. ft.
5. If the sign is to be twc faced give the number of square feet of each
face 5/ sq. ft. Estimated cost of construction$
6. If the sign is to illuminated, check appropriate box.
Interhal ( ) , External ( ) , Spot ( ) , Neon ( ) , Flashing ( ) ,
Oth ) .
7. Copy of sign 7,,9/ Cd i /—A1 ZCy •
8. Other information s`rN /eZhlG7/44:77/) // 1 G
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Signit.0 e of applicant,
Indicate Owner, Contractor,
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or Agent.
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APPROVED
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