CITY OF COOKEVILLE
DEPARTMENT OF CODES
PERMIT APPLICATION FOR ON-PREMISE SIGN
PERMIT #
SIGN NAME BP#
STREET ADDRESS ZONE
PROPERTY OWNER
Yes No
Affidavit of Permission from Property Owner
SIGN CONTRACTOR Phone
ADDRESS
Liability and W/C Insurance Compliance Received
Yes No
Yes NoYes No
Compliance Affidavit
SIGN INFORMATION:
Sketch/Site Plan Attached
Freestanding # Wall #
Total # Existing Freestanding Signs Wall Dimesion
Total Existing Display Area SF # Walls Used
# Signs per Wall
% Wall Used
Total # of Street Frontage
Length of Street Frontage Per Street
Display Area SF Display Area SF
Total Height
Height to Bottom Edge of Sign
Mansard/Roof #
Distance of Leading Edge of Sign to ROW
Distance to Existing Sign
Mansard/Roof Dimension
# Mansard/Roof Used
# signs per Mansard/Roof
% Mansard/Roof Used
Display Area SF
Projection #
Display Area SF
Other
Display Area SF
Mobile
Deposit $250 Received
Expiration Date
ENGINEERED DRAWINGS REQUIRED:
Yes No
Date Received
ELECTRICAL POWER REQUIRED:
Yes No
ELECTRICAL INSPECTION PERMIT #
UL APPROVAL #
PERMIT FEE DATE PAID
Certification: I, the undersigned, hereby certify that is my responsibility to assure that signs approved by this permit are located and erected in
compliance with the General Sign Regulations of the Cookeville Zoning Code.
Applicant Signatature Application Date
Sign Inspector Issue Date
Approval of Installation Date
NOTE: THIS PERMIT SHALL BE NULL AND VOID IF THE WORK AUTHORIZED IS NOT COMMENCED WITHIN SIX (6) MONTHS OR IS NOT COMPLETED
WITHIN EIGHTEEN (18) MONTHS FROM THE DATE OF ISSUANCE
NOTE: THIS PERMIT SHALL NOT BE VALID UNTIL ALL REQUIRED INFORMATION AND FEES HAVE BEEN SUBMITTED
Application Revised 8/8/05
