97-3028 IOW Fee Paid: GO , OO
imit TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804 Approved By:
(518) 761-8256 Permit #:
c-17 --,_3(-)A)
SIGN PERMIT APPLICATION
THE FOLLOWING INFORMATION IS REQUIRED: r ' f
r,` { 1997
L
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 BO qC,H (4 IC_
ADDRESS 3S 02 C I-1Al'ai D e 1 U�- c_ a Ce Alf 6aityTEL.
NAME OF APPLICANT /9, ,2/T h-1Ce...,;%o,v s JV 11 re, 5-- / is
ADDRESS d be /ed ,/ c.)zi_ cv`,s TEL. 77s- e4 26
BUSINESS NAME IF DIFFERENT: TJt. 1.tJT.) J S c rzulI e CCL'/LJ L'Z
TYPE AND LOCATION
Check What Applies: Existing _ Permanent ✓ Projecting Sign __
Temporary Non-conforming Existing __
Free-Standing _ Wall ✓_ New __
Location: Tax Map Number _14.9 - / - 7
Address 12�Gc yl .-( _
Proposed Setbacks from Property Line (front) 3 g ' (side) 3 3-
If sign is to be illuminated, please check appropriate box:
Internal v.) , External ( ) , Incadescent ( ), Neon ( ) , Other ( )
Size of Sign: Width / ft. Length r _ ft.
Total Square Footage: _ ,3
Sign Copy: ' v S'.,4-s / ,ti.t,,c.i..,,,i ,5*--9;//,,,Af6" Ocktv...,_)
Color and Material To Be Used: ac, .
Signature:
Circle One/ pplicant owner, contractor or agent.
I HEREBY AUTHORIZE APPLICANT TO P A SI ON MY PROF 1Y OR BUILDING.
Signature of Property Owner: _... ___
ORIGINAL-Office Copy COPY-Applicant
?Zeu'to#o &fat, Sam
29 Saratoga Road
Gansevoort, New York 12831
(518) 745-8676
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