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� <br />� � <br /> City of Orono <br /> Temporary Sign Permit Application <br /> O Mailing Address: � c� -- , <br /> PO Box 66 Permit number: Z U �i'� C <br /> � �� C rystal Ba y, MN 55323-0066 Date received: 1 j � Z � � � <br /> Street Address: Received bv: �� <br /> 2 ; 2750 Kelley Parkway Permit Fee: $35.00 <br /> `�t �,�' Orono, MN 55356 <br /> �kESHo¢ � <br /> � ; �/Z �15 If mailing, add$2.00 <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. �1 <br /> Incomplete applications will be returned. (Please print) �..�" `�� <br /> SIGN LOCATION ADDRESS: 2765 Kelley Parkway <br /> BUSINESS INFORMATION: <br /> Name: Orono Dental Care <br /> Address: 2765 Kelley Parkway Citv: Orono ZIP: 55356 <br /> Contact Person: Dr. Karl Berq— Dr. Mike Skramstad <br /> Phone: 952-449-9494 <br /> Email and/or Fax drberq(a�oronodentalcare.com - drskramstad(c�oronodentalcare.com <br /> APPLICANT(RESPONSIBLE PARTY): <br /> Name: Orono Wrestlinq Club <br /> Mailing Address: Citv: ZIP: <br /> Contact Person: Joe McPherson ��12 �t�c;� <br /> Phone: 612-369-3736 (Mobile) <br /> SIGN COMPANY/OWNER(IF NOT SAME AS BUSINESS): <br /> Name: A Plus Performance Signs <br /> Address: 809 Pacific Avenue Citv: Waverly ZIP: 55390 <br /> Contact Person: Jason <br /> Phone: 763-390-5645 <br /> PROJECT INFORMATION: <br /> Type of Sign: Size of Sign: Location of Sign: Dates Sign to be Displayed: <br /> �Portable Reader board 7 K rk N v — v <br /> ❑ Banner <br /> ❑ A-Frame <br /> ❑ Balloon <br /> ❑ Other(specify) <br /> For signs not attached to a building, provide location sketch on back of application. <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Violation of City Ordinances is a misdemeanor. Each day the violation continues in existence shall be deemed a separate <br /> violation; <br /> • The City may,without notice, remove any temporary sign erected in violation of city, state or federal regulation; <br /> • The si n s , si n su orts or ortable tand must be remo�ed from ublic view at the end of the ermit eriod. <br /> � , <br /> Applicant Signature: � �� ' �� ���J �� Date: //'%�J—��� <br /> For Multi-Tenant Buildings: � , Z � ! <br /> Property Owner or Manager Signature: � Date: r 1 <br /> Printed Name of Property Owner or Manager: DR. KARL BER � <br /> .-- <br /> Phone Number: 952-449-9494 E ' d ess: drberq(a�oronodentalcare.com <br /> w:\(applications,license or permit applications)\sign permit- mporar rLapplica�ion v1.doc <br /> Updated: 03/25/2015 <br />