Rev. 8/14
TOWN OF MIDDLEBURG
10 West Marshall Street, PO Box 187
Middleburg, Virginia 20118-0187
540-687-5152 FAX 540-687-3804
SIGN PERMIT
Applicant Name: Business Name:
Mailing Address: Phone #:
email:
Contractor Name: Phone #:
email:
PROPERTY ADDRESS: Parcel #:
Owner Name: Phone #:
Mailing Address: email:
Zoning District: In Historic District?: No Yes COA #:
Building Frontage: Front: ft. Side (if corner lot): ft. Existing Signs(sq ft):
Type of Sign: Wall Projecting Freestanding Window Awning Other
Height above ground at Sign's: Lower edge Upper edge Height of Sign Structure
Sign Dimensions: Height Width: Area in sq ft: Number of Faces:
Sign Material: Location of Sign:
continuation sheet attached (if applying for more than one sign)
I do hereby request a sign permit for the sign(s) described herein and as shown on the attached plans and
specifications. I agree to comply with the conditions of this permit and all other applicable town requirements:
Applicant Signature: Printed Name:
I, as owner or authorized agent for the above-referenced parcel, agree to the installation of the proposed sign(s) on
the property described above:
Owner/Agent signature: Printed Name:
OFFICE USE ONLY
Date Filed: Fee amount: Date Paid: Application #: S
Conditions of Approval:
Approved: Date:
Zoning Administrator
THIS PERMIT EXPIRES ONE YEAR FROM THE APPROVAL DATE IF THE SIGN IS NOT INSTALLED AS APPROVED.
THIS SIGN PERMIT IS NOT TRANSFERABLE.
Application # S ____________
