Fill - Free fillable SignApplication - Sign Application

Form1204(4.3.20)

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PermitNo.

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CITYOFBRIDGEPORT,BUILDINGDEPARMENT

APPLICATIONFORSIGNPERMIT

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Date_____________

Toerectasign OnStreet

Sizeofsign OwnerofLand

OwnerofSign Owner’sestimateofvalue

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SignErector Address

SignErectorPhone Email

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CommoncouncilApproval

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ApprovedBy R.No

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SignFee:

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Theundersignedherebymakesapplicationforapermitfortheerectionofasignassetforthintheaccompanying

drawingsandspecificationshowingconstructionandmethodoferectionasrequiredbytheBuildingDepartment.

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Ifhungonwallsofbuildinggivethicknessandmaterialofsame

Ifonaroof,giveconstructionofroof

Constructionofsign

Locationofsign(Streetandnumber)

(Owner's)(Agent's)Signature

Address

Signcontractor

Address

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TYPEOFSIGN

GroundSignRoofSignWallSignMetalBoxElectricMarqueeChannelLetters

Lengthofsign Height Weight

Maximumheightofsignfromtheground

Isilluminatedsignlisted builtwithlistedcomponents

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CONSTRUCTION

MetalWoodPlasticwithMetalFrame

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METHODOFERECTION,BRACES,ETC.

Sizeofangleorflatirons chains,cablesorsignhooks

Lagbolts,etc. size,length&spacing

Remarks

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HOLDHARMLESS/RELEASE

CityofBridgeportandBridgeportBuildingDepartmentrequirethatpermitteeshallindemnifyandhold‐harmless"City/Department",itsemployees

andagentsandreleasebothfromanyandallclaimsonactionsbroughtbythirdpartiesforinjuriesordamagesofpropertyinconnectionwith

grantingofthispermitandworktobeperformedthereunder.Permitteemayberequiredtoinsureagainstsuchclaimsinamountsappropriateto

meetsuchobligation.City/Departmentshallhavetherighttoreviewandspecifysuchamountandscopeofcoverageasitmaydeemappropriate

foractivitiesconductedunderthispermit.

SignatureofOwner/Lessee

SignatureofContractor

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SignApplication - Sign Application - Draft Revised

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