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City of Prior Lake
APPLICATION FOR SIGN PERMIT
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DIRECTIONS: One completed application per sign is required. Applicant is - --
= . RCEL LD. OF PROPERTY:
responsible for obtaining a building permit if necessary.
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2. APPLICANT: (NAME) (ADDRESS) (PHONE)
Qm T£CF/ (0077 LAK£ £ Vj 01,'. ` n ,,,/ 9- rr•A.- 6,,,,i SS CY" L St -y3J 711yp
3. OWNER: (NAME) ' (ADDRESS) T (PHONE)
t�[.oxr 4t 10IP74'fi 1 156 , 7 c4✓J w• BCr7r» +.�[ -.7y�+ �ar.� 5543J Y5Z .7c•�
4. SITU ADDRESS OR LOCATION OF SIGN (PHONE)
l&600 bJLt %2� rot /£. SC. /r'SL - AO/ 7 -5051
5. TYPE OF SIGN: TEMPORARY(21 DAYMAmmumDISPLAY) PERMANENT( WALL /MARQUEE/AWNING /FREESTANDING)
Eafioa =• 4nare ^•.Business *Changeable Copy Signs * Construction Signs'Eluminated ,Signs•Insdtudonal Signs•Lake Service Signs*
Multiple Residential Nameplate Signs•On- Premise Directional Signs-Permanent Mudow Sign•Poriable S'ign•Subdivision Identification Signs
6. SIGN DIMENSIONS
10. Estimated Value of Sign
(square feet) (Height) (Width) (Depth)
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13. Completion Date
Z- 3 + -ti S
7. TYPE OF CONSTRUCTION
8. PROPOSED DISPLAY DATES (if applicable)
SIGN PERMITS WILL NOT BE PROCESSED IF THEY ARE INCOMPLETE
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. 1 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 perfarm need inspections.
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SIGNA OF PROPERTY OWNER/AGENT DATE
FOR ADMINISTRATIVE USE
S REQUIREMENTS
X Completed Application
Scale Drawing showing location of sign
Flans and Specs
Permit Fee $ (Permit fee is set
at time of application according to approved schedule)
This Application become your Sign Permit when approved.
ny 4ZO
ity PI!Pafr or designee
Date P PVC — a7
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 compliance with the Sign Ordinance.
Special Conditions
24 Hour Notice for All Inspections
4474230 from 9:00 a.m. - 10:00 a.m.
lAhandoutskign form.doc
'STATIONS 1 10 -4-07 1 GJR rxerew,,.,irnepa >nrva
File Name:
LAKE, MN 47164 -PYLON WITH LED MESSAGE CENTER