2003-996 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: P20030996 Application Number: A20030996
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 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 Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2003-996 BODY RELIEF
9 SQ FT WALL SIGN
$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 f Que sb T s eeember 18,2003
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Fee P P
aid: 00
TOWN OF QUEENSBURY _ J-I
742 Bay Road, Queensbury, NY 12804 Approved By:
(518) 761-8256 Permit #:
SIGN PERMIT APPLICATION
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 IF-n 71,
J �
ADDRESS RT 41 TEL. Y# I
NAME OF APPLICANT 6 eQ)PA Z)2, ad i Q7�
-6) , mfo"6 -zq- ' --)9 ADDRESS 9S S41 0 -c� TEL. (006
BUSINESS NAME IF DIFFERENT: f-Indc,
TYPE AND LOCATION
Check What Applies: Existing Permanent Projecting Sign
Temporary Nan-conforming Existing
Free-Standing Wall New
Location: Tax Map Number
. 4�-(�__; - ' kC).Caj -PjqZr;�,
Address J��J C1 f
Proposed Setbacks from Property Line (front) (side)
If sign is to be illuminated, please check appropriate box:
Internal ( ) , External � , Incadescent Neon Other
r If Size of Sign: Width ft. Length -1 ft.
Total Square Footage:
Sign Copy: _,60d LA R"p-JI-41
Color and Material To Be Used: act aqA 144 C0 10 r- KwA-`4_
Signature: OW&M
Circle One: AppTicant, ofter, contractor or agent.
I HEREBY AUTHORIZE APPLICANT TO PLACE A SIGN ON NY PROPERTY OR BUILDING.
Signature of Property Owner:
ORIGINAL-Office Copy COPY-Applicant
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