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-a .f.:Y- iCn2- •a._�: rraRa.'1.fl>' . •° .._-."i t .y n, "o.:a$d-, m '-'$3�)_- d:' . - a•.""s"k TEMPORARY SIGN SIGN PERMIT APPLICATION 4-
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TOWN OF QUEENS,:URY O rn1 PERMIT NUMBER:
Dept. of Community Development V U
742 Bay Road S�f s Fee Pai SO,C)a 7.
Queensbury,New York 12804 200T C� o/G� ��� (`
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TOWN OF OUEC=i�'SQURY Deposit Pa'
AncoDE
ant Notice: -
Temporary Sign Permits are issued for a period of 12 calendar days not to exceed 60 calendar days per year
/� per applicant. Exception-political signs-(see attached Local-Law).._ __.- _
r
hIAA : placement of sign: r /,,?(/O ( DATE: removal of sign: / /
Applicant Name(individual or business name): '1 S C�� `,�� l_® ,.,-,
/_, ,
r►� 15 Mailing Address: /�'1� c,it / ( `/1�'�myte ,Telephone No. ( ) -, D L- 3 3 . W 1
' i-D $fl) z-ckr., G-z ecn1-‹ Y !
Exact Location/Placement of Sign: fi �A-i_ NIA ,.,,Q . ,
n
Tax Map Number: Section , Block , Lot A
Type of Sign: (only one [1] sign allowed per permit-exception) ' "
Political Signs ONLY (to be placed 60 days prior to event)
Sign Copy for Political Sign: - -
Wall Si (not to exceed 32 square feet Sign rey. "\\ ok)--•-(
I Freestanding Sign(not to exceed 16 square feet) Sign Copy:
— -SIZE OF SIGN: J - -x :0; - �� sq. f- - — —
, ir- /,-1.2. ____
si attire of applicant signature of property owner if
different from applicant name
Failure to remove sign at expiration may result in forfeiture of deposit as per the
Code of the Town of Queensbury, Section 140, Subsection 140-4 (Local Law No. 11, 1993).
Send Refund- deposit to: