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Revised: July 2020
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.)
Existing Signage
# of existing free-standing signs:_______ Total Area (sq. ft.):_______
Proposed Sign Details
# of proposed free-standing signs:______ On Premises: Yes No
□ Alter
□ Erect
□ Move
□ Reface
□ Repair
SIZ
E:
Area (sq. ft.) ______
Length (ft.) _______
Width (ft.) ________
FRE
ESTANDING or
MONUMENT ONLY:
SIGN VALUE:
□ Fascial/Wall
□ Freestanding
□ Ground
□ Monument
□ Pole
□ Portable
□ Projecting
□ Billboard
□ Marquee
Height (ft.) _____
$______________
□ Business
□ Gen. Advertising
□ Construction
□ Identification
□ Church
□ Directional
□ Directory
□ Farm
□ Home Occupation
# of Supports _____
□ Single Face
□ Face to Face
□ V-Shaped
□ Wall
ILL
UMINATED:
□ 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:__________________
Montgomery County, Virginia
Application for Zoning Approval of Sign Permit
755 Roanoke Street, Suite 2A, Christiansburg, VA 24073
(540) 394-2148 | mcplan@montgomerycountyva.gov
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