SIGN PERMIT APPLICATION
Page 1 of 2
Job Street Address:
Date:
City & Zip:
Name of Business:
Parcel ID: - - - - -
Owner Name:
Address:
City:
State:
Zip:
Phone:
Fee Simple Titleholder’s Name (if other than owner’s):
Address:
City:
State:
Zip:
Contractor Company:
License Holder Name:
License Number:
Address:
City:
State:
Zip:
Phone:
Fax:
CONTACT PERSON:
PHONE:
EMAIL:
FAX:
Description of work:
PROVIDE THE FOLLOWING INFORMATION (INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED)
1. Total estimated valuation: $
2. Square footage of existing copy area to remain: Building: SF Ground:
SF
3. Total square footage of new copy area: Building:
SF Ground: SF
4. Lot Frontage: LF
5. Building Frontage: LF
6. Sign Manufacturer:
7. Is the proposed sign electrically lighted? Yes No
8. Estimated valuation of electrical work: $
9. Name of recognized test lab & number:
10. Type of sign (check all that apply):
Billboard Ground Mechanical Lawn Wall Sign
Single Faced Double Faced Transportable Neon Temporary
(Continued on next page)
Permit #
Workers Comp. Verified:
SIGN PERMIT APPLICATION
Page 2 of 2
Subcontractor’s
License Number:
Business Name and/or License Holder’s Name
Building
Electrical
NOTICE: This application becomes null and void 180 days after the date of filing, unless such application
has been pursued in good faith or a permit has been issued. Extensions may be granted by the Building
Official if requested in writing and justifiable cause is shown.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND
CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE
AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERMANENCE OF CONSTRUCTION.
The valuation for this permit will be calculated using the ICC Building Valuation Data. By my signature, I
acknowledge this fact and waive any rights to appeal said valuation and/or permit fees.
ELECTRONIC SUBMISSION STATEMENT: Under penalty of perjury, I declare that all the information
contained in this building permit application is true and correct.
Printed Name:
Signature of Contractor:
Date: