97-3029 /010` Fee Paid: —70),
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804 Approved By:
(518) 761-8256 Permit #: ] 7-36,72.
SIGN PERMIT APPLICATION
THE FOLLOWING INFORMATION IS REQUIRED:
APR I') - .
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 ant/cot( 1.
ADDRESS 3.1- O rZC 1-4k 21 la' tli' TEL.
NAME OF APPLICANT / Pea) ra s
ADDRESS r Gl1�_�,r n� TEL. 7 yU - Y6 76.
BUSINESS NAME IF DIFFERENT: /Je ,tjTO/JS Sure V LC_�—
TYPE AND LOCATION
Check What Applies: Existing _ Permanent Projecting Sign __
Temporary Non-conforming Existing __
Free-Standing _ Wall ' New __
Location: Tax Map Number /0 f - / - ;
Address 1� 4 12e-- _ ( .--
Proposed Setbacks from Property Line (front) _ (side) _
If sign is to be illuminated, please check appropriate box:
Internal (mil, External ( ) , Incadescent ( ) , Neon ( ) , Other ( )
Size of Sign: Width _3 ft. Length 4/ — ft.
Total Square Footage: _ 3 G*
Si gn Copy: /Vete re; s l`vv 5.¢/6•---S
Color and Material To Be Used: 1.,-9A T
Signature:
Circle One: plican owner, contractor or agent.
I HEREBY AUTHORIZE APPLICANT TO E SIGN 1 „ ""OPERTY OR BUILDING.
Signature of Property Owner:
ORIGINAL-Office Copy fit
Weave/Ai cofato Saes
29 Saratoga Road
Gansevoort, New York 12831
(518)745-8676
to 6 t 117fxcW fv Sa
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