Building & Zoning Department
215 S. Broadway, Louisburg, KS 66053
913-837-5811 ·
Date: ____________ Permit # ______________________________
Applicant Name: ____________________________________________________________________________________
Property Owner: ____________________________________________________________________________________
Property Owner Address: __________________________________ City_____________________ State ____ ZIP ______
Phone: __________________________________ Builder/Contractor: _________________________________________
Estimated cost of new construction: _____________________________________________________________________
Size of structure: Width ____________ Length ____________ Height ____________
Sign Classification (circle one) 1. Awning, Canopy or Marquee 2. Ground 3. Projecting 4. Wall 5. A-Frame 5. EMC
Will this sign be illuminated______ or Electronic Message Center ______?
Will this sign be used for Goods, Products or Services that are not available on the same site as this sign? _____ Yes
Zoning district in which this sign is located: _______________________________
Size of Sign Face (square footage) ___________ 1-sided sign ___________ 2-sided sign
Describe present use of land within 50 feet of any boundary line. _____________________________________________
I, ______________________, hereby certify that the information provided herein is true and correct and that all Zoning
Regulations shall be complied with. I further understand that any permit based upon false or incorrect statements of a
material fact necessary to the issuance of the permit, shall be void.
Date: _____________ Signature: __________________________________________________
Office Use Only
_________ Sign Drawings _________ Receipt # _________ Amount Paid _________ Date Paid
Assigned address: ___________________________________________________________________________________
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