Rev. 8/14
TOWN OF MIDDLEBURG
10 West Marshall Street, PO Box 187
Middleburg, Virginia 20118-0187
540-687-5152 FAX 540-687-3804
TEMPORARY SIGN PERMIT
Applicant Name: Business Name:
Mailing Address: Phone #:
email:
PROPERTY ADDRESS: Parcel #:
Owner Name: Phone #:
Mailing Address: email:
SIGN DESCRIPTION:
Function of Sign: Temporary Business Sign (while permanent sign is under review)
Temporary Window Sign (attached to the interior of the window)
Construction Site Sign Residential Development Sign
Real Estate Sign Political Campaign Signs
On-site Special Event (Grand Opening, Fair, Festival, etc)
(See separate form for use of Town Sign Structures for Off-Site Special Event signs)
Date sign to go up: Date sign to be taken down:
Type of Sign:  Wall  Freestanding Window Other
Sign Dimensions: Height Width: Area in sq ft: Number of Faces:
Sign Material: Location of 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 #: ST
Deposit Required: Date Paid: Date Refunded:
Conditions of Approval:
Approved: Date:
Zoning Administrator
THIS PERMIT EXPIRES ___________________ . THIS SIGN PERMIT IS NOT TRANSFERABLE.
Application # ST ____________
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