Revised: Feb 2021 SUBMIT COMPLETED APPLICATION TO: mcplan@montgomerycountyva.gov
OWNER/APPLICANT INFORMATION
Owner: Applicant/Agent:
Phone: Phone:
Address: Address:
Email: Email:
Name of Business:
911 Address for Property:
Tax Map Number: Zoning Class: Parcel ID:
REFERENCE SECTION 10-45(2) FOR SIGN DEFINITIONS (Mark all that applies in each section.)
# of existing free-standing signs:_______ Total Area (sq. ft.):_______
# of proposed free-standing signs:______ On Premises: Yes No
ACTIVITY:
□ Alter
□ Erect
□ Move
□ Reface
□ Repair
SIZE:
Area (sq. ft.) ______
Length (ft.) _______
Width (ft.) ________
FREESTANDING or
MONUMENT ONLY:
Height (ft.) ________
# of Supports ______
TYPE:
□ Fascial/Wall
□ Freestanding
□ Monument
□ Portable
□ Projecting
□ Billboard
□ Marquee
USE:
□ Res
idential
□ Residential Community /
Subdivision Entrance
□ Non-Residential / Commercial
SIG
N VALUE: $____________
STRUCTURE CONFIGURATION:
□ Single Face
□ Face to Face
□ V-Shaped
□ Wall
ILLUMINATED:
□ Direct Light
□ Indirect Light
□ LED*
□ Non-Shielded Illuminated
□ None
□ Other (describe) _________________
□ LED* Sign Area (sq. ft.) ___________
(Required if LED chosen above)
□ Scale drawing of sign including dimensions.
□ Scale drawings of wall signs, which indicate placement on building.
□ Scale drawings of free-standing signs, which indicate height above grade and height of main structure on the
premises.
□ Site plan showing location and set back distance of Free-Standing Sign(s).
□ Application Fee: $50.00 (Note: Payment is required with application.)
I certify that the information supplies on this application and on the attachments provided is accurate and true to the best of my knowledge. I
further understand a setback of ten (10) feet from all property lines is required.
Owner’s Signature: Date:
Applicant/Agent’s Signature: Date:
Application for Zoning Approval of Sign Permit
755 Roanoke Street, Suite 2A, Christiansburg, VA 24073
(540) 394-2148 | mcplan@montgomerycountyva.gov
