HomeMy WebLinkAboutSign Permit 98-046 - GoldCare Vision Clinic
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White - Applicant
Yellow - City
City of Prior Lake
APPLICATION FOR SIGN PERMIT
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DIRECTIONS: Spaces numbered 1 thru 10 must be filled in before permit is issued
(Plea prin or type, and sj~ where required .1
re' Y;.5;~r" Silt C;;.,rf'tvc, Sf. s,c
2. APPLICANT: (NAME) (ADDRESS)
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3. OWNER: (NAME (ADDRESS) Po vI
5'"1/ c. Qc,k t<,c,v 51. s: /;"
4. SITE ADDRESS OR LOCATION OF SIGN
p..e, W7Q;-J~~ I
5. TYPE OF SIGN: TEMPORARY (21 DA Y MAXIMUM DISPLAY) PERMANENT (WALLlMARQUEE/A WNING/FREESTANDING)
Balloon * Banner*Business*Changeable Copy Signs*Construction Signs*Illuminated Signs*Institutional Signs*Lake Service Signs*
Multiple Residential Nameplate Signs*On-Premise Directional Signs*Permanent Window Sign*Portable Sign*Subdivision Identification Signs
Tim
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(PHONE)
6. SIGN DIMENSIONS
(square feet) (Height)
ao~ d'
7. TYPE OF :;:;~:R~ON
8. PROPOSED DISPLAY DATES (if applicable) AJ (A-
SIGN PERMITS WILL NOT BE PROtESSED IF THEY ARE INCOMPLETE
10. Estimated Value of Sign
(Width)
10'
(Depth)
11. Completion Date
I hereby certify that I have furnished information on this application which is, to the best of my knowledge, true and correct. I also certify that I am the owner
or authorized agent for the above-mentioned property, and that all construction will conform to all existing state and local laws and will proceed in accordance
with submitted plans. I am aware that the City Planner can revoke this permit for just cause. Furthermore, I hereby agree that City Officials or a designee
thereof may enter upon the property to perfo n eded in ect~. U
LA U if-I-crr
DATE
FOR ADMINISTRATIVE USE
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SUBMISSION REQUIREMENTS
~omPleted Application
" ,~cale Drawing showing location of sign
. . . ~ans and Specs '2.j) 4t)
.' Permit Fee $. (Permit fee is set
at time of application according to approved sche~ule)
By
Date
qT;T~rgesignee
This is to certify that the request in the above application and accompanying documents is in accordance with the City Sign Ordinance and may proceed as
requested. This document, when signed by the City Planner or designee constitutes a temporary Certificate of Zoning compliance and allows construction to
commence.
Special Conditions
WIIllDow
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Received of
the sum of
for the purpose of
$ (oJ, i-)O
CITY OF PRIOR LAKE
16200 EAGLE CREEK AVE SE
PRIOR lAKE, MN 55372
RECEIPT # 32424
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DATE:8(lH( /1, {15
dollars
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Receipt Clerk for the City of Prior lake
BUILDING PERMIT #
BUILDING PERMIT #
Building Permit Fee
Plan Check Fee
State Surcharge
Plmb Pmt pp#
Mech Pmt mc#
(Heating only - $65.00)
(Htg & Air - $100.00)
(Fireplace - $40.00)
(Air - $40.00)
Swr/Wtr Pmt sw #
Other
Total
1,200.00
700.00
1,500.00
Building Permit Fee
Plan Check Fee
State Surcharge
Park Support Fee
SAC
Plmb Pmt pp#
Mech Pmt mc#
Mech Pmt mc#
Swr/Wtr Pmt sw#
Pressure Reducer
Water Meter
Tree Preservation Deposit
Swr/Wtr Connection Fee
Water Tower Fee
Builder's Deposit
Other
Total
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