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•� - � � <br />�, � . , ' � � <br /> - ..-- - —....... .-.NN��a.a�.1UR <br /> �Q� Mailing Addre,ss <br /> Q PO Bax 66 Permit num}��r. e?D��j -(f��� <br /> Crystal Bay,IIqN 55323-U066 Uate reoeived: �,/�1 <br /> y � � Stiaet Address Received by: <br /> o t C 27501Geiley Parlcway <br /> �' �'��rs w o��' Orono, MN 55356 • p�it Fee: � <br /> . <br /> Main: 952-249�6Q0 Fax; 952 249-46i6 www�i orono mn us � <br /> This application form must be completed in fi,tPJ and af!required informatian must be submitted. <br /> lncomplete applications wlll t�returned. �Pfe�se priRt) <br /> GENERAL INFOl2MATI�N; <br /> Site Address: y • t„ <br /> Street Fforrtage of Property z1�� _"' <br /> ��� <br /> Existing Sign: Size of ExistEng Sign: <br /> Existing Mabarials: F�cisting 1lfumination: <br /> ❑ Needs reptacing Sign Face Ler�g�h: <br /> Q Waod ❑ �emal <br /> � I�eeds Alleration f Sign Face y�/idth: <br /> Faoe Change ❑ Plastic ❑ lnterrtal <br /> Q �ther(specifY? T°�i Squane Footage:1_ ❑ Metal <br /> ❑ fndirect <br /> Top of Sign to Grade_ <br /> ❑ Other tspeatYE ❑ Other{specifY) <br /> Distance from Bottom <br /> of Sign Oo Grade; <br /> O+WN�R tMFpRMATlONF: <br /> Name: --� � � <br /> Address: �� <br /> c. L <br /> Corttact Persorr: �' C�Y= !Zv ZiP: <br /> Phone: <br /> Emai!and/or�ax <br /> CON7RAC�'OR/qpp�,�CANT: <br /> Name: •�� � <br /> Mailing Address_ L t �f� '� �G- �, <br /> Cor�tact Person: �' Ci�: - ��y,� ZIP: 3 <br /> Phone: <br /> t✓�yu t.�_ � . <br /> � y� '_ - �/�l' - o-- S Sz� <br /> Es6mated ConsEruction Va1ue � * <br /> '�'v��^�°�is f.o be done per IBC <br /> PROPOSED SIGN INFQRMATIpN: <br /> 7YPe of Proposed Sign: Size of P <br /> �po�d 5ign: Proposed Nlate�'rals: <br /> �"' � Proposed lilumination: <br /> New Sign Instattation Sign Face Length: � � <br /> ❑ Wood Extema! <br /> ❑ Slgn Alteratlon/ � <br /> Sign Face Width: <br /> Face Change � ��� Interna� <br /> Tota!Squars i�oMage: I�� <br /> ❑ QEher(speaFY1 '^—�---- ❑ �I ❑ lndinect <br /> � �� <br /> Top of Stgn to Grade; <br /> _ ❑ Other{s}�eci�y) ❑ pther(specifY) <br /> Distance trom Bottom 0 � <br /> of Sign to Grade: Q <br /> A Minaesota S'�ate Elect�ri�I P�if is require�f if electrical vYork is propos� <br /> ��j- �pOt,-�- � <br /> E'd 6£9Z-699-E9L �u� ��lal�el� 'l'W'S hcZ�ZO £� E� �nf <br />