2003-655 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030655 Application Number: A20030655
Tax Map No: 523400-296-013-0001--018-000-0000
Permission is hereby granted to: COMARTNTTY-WORK SHOP
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 Budding Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: GUIDO PASSARELLI
sign
465 LAKE Ave Total Value
LAKE LUZERNE, NY 12846-0000
Contractor or Builder's Name Address, Electrical Inspection Agency
Plans&Specifications
2003-655 CWI (Community Workshop) Location: Store
Mount Royal Plaza
20 SQ FT PROJECTING SIGN ON FRONT WALL AS PER APPLICATION
$40.00 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 To August 27, 2003
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY - - Fee Paid:
742 Bay Road, Queensbury, NY 12804 Approved By:
(518) 761-8256 Permit #: 0
SIGN PEPj41T APPLICATION
THE FOLLOWING INFORMATION IS REQUIRED: SEC ENED
1. Detailed drawing or photo of sign. AUG 1. 1 2003
2. Plot plan of location of sign. TOWN OF QUEENSBURY
3. - Wr.i.tten—consent of the owner of the building or land.
BUILDING AND CODE
OWNER OF PROPERTY _1`lam nZ EStil-1-
ADDRESS %57 cl ST C06 lo W TEL.
NAME OF APPLICANT
ADDRESS rl
BUSINESS NAME IF DIFFERENT:
TYPE AND LOCATION
Check What Applies: Existing Permanent Projecting Sign -,� <\
Temporary Non-conforming Existing
Free-Standing Wall New
Location: Tax Mai) Number
Address
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 f t.
Total Square F tage: _ '5�0
Sign Copy:
Color and Material To Be Used: V"//�JA_
Signature:
rcle One: �1��icant, owner, contractor or agent.
I HEREBY AUTHORIZE APPLICANT TO PLACE A SIGN ON MY PROPERTY OR BUILDING.
Signature of Property Owner:
ORIGINAL-Office Copy COPY-Applicant
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I
RECEIVED
AUG, 112003
i TOWN OF QU�EENSSURY
BUILDING AND CODE
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