2004-874 Tackett Chiropractic Center TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040874 Application Number: A20040874
Tax Map No: 523400-302-008-0002-006-000-0000
Permission is hereby granted to: TACKF.TT CHMOPRAC;TTC CENTER
For property located at: 19 HOMER Ave
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. Tyne of Construction Value
Owner Address: MIBENACK, LLC
14 FOX HOLLOW Ln Sign
Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
SICrN CRAFT
PO BOX 332
GLENS FALLS_ NY 12801-0000
Plans&Specifications
2004=874 TACKETT CHIROPRACTIC CENTER'
27 SQ FT FREE STANDING SIGN(includes the'3 sq. ft. tag sign)
$54.00 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 n of ens ; � r d ember 19, 2004
SIGNED BY �d for the Town of Queensbury.
Director of Building&Code Enforcement
Fee Paid: U lU
TOWN-OF QUEENSBURY
Bay at Haviland Road, Oueensbury, NY 12804-9725-518-792-5832 Approved By:
Permit #: 6 4_,U p /
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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
ADDRESS TEL. -7
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NAME OF APPLICANT _ S SI�1•� C✓' sr
ADDRESS y: l�i�✓` 3 Z: / 1/ TEL.
BUSINESS NAME IF DIFFERENT: '/1CPQ44 (L
TYPE AND LOCATION
Check What Applies: Existing —_ Perm�pent —_ Projecting Sign —_
Temporary Non-,conforming Existing _
Free-Standing L,--" Wall _ New
Location: Tax Map Number 3
Address
Proposed Setbacks from Property Line (front) S (side) S
If sign is to be illuminated, please check appropriate box: gee.
Internal ( ) , External ( ) , Incadescent ( ) , Neon ( ) , Other
Size of Sign: Width f Le gth %` ft. ►
s S c rr
Total Square Foota e:� �� -, ,, :-,W:�
Sign Copy: ,s x Sf Ij5
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Color and Material To eUsed:
Signature: Xe
Circle One: /Applicanj, owner, 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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MAILING: SHOWROOM:
P.O. Sox 332 • Glens Falls, NY 12801 52 Main Street • Queensbury, NY 12804
ph. 518-792-4009 fx. 518-792-4476
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