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<br />y NJ!1t <br /> <br />,...- <br /> <br />COMMUNITY DEVELOPMENT DEPARTMENT. PHONE: 651-490-2238 . FAX: 651-490-2931 <br /> <br />SIGN PERMIT APPLICATION <br /> <br />PERMIT NUMBER: <br /> <br />WORK PROPOSED: 0 New Signage <br />APPLICATION DATE: <br /> <br />o Face Replacement <br /> <br />o Temporary (Dates: <br /> <br /> <br />Pone: <br /> <br />ess: <br /> <br />OWNER: <br />Address: <br /> <br />ame: <br /> <br />Pone: <br /> <br /> <br />CONTRACTOR: <br />A ess: <br /> <br />Name: <br /> <br />VALVA TION (labor & materials): <br />WORK DESCRIPTION: S. <br /> <br />SIGN DETAILS: <br /> <br />o Free Standing <br />o Wall <br /> <br />Width: <br /> <br />o Illuminated <br />o Non-Illuminated <br /> <br />Height Above Grade: <br />I <br />% of Wal,l Area: <br /> <br />SIZE OF SIGN: <br /> <br />FRIT ST.\NUIi\(j SICii'\ I:-.JF( )"i\1 \TI<)\:: <br /> <br />Height: <br /> <br />Sign Location: <br /> <br />Setbacks I Front: Side: Other: <br /> <br />Acknowledgement and Signature: <br />The Wldersigned hereby makes &pplication 10 the City of Roseville 10 perfonn the work as herein described. The Wldersigned further states, under penally of <br />law, thai the work will be performed in &ccordance wilb the Minnesota State Building Code, Ibis application, and any approved plans and/or specifications, <br /> <br />Print Name: <br />o Contractor 0 Owner 0 Other: <br /> <br />Signature: <br />Phone: Date: <br /> <br />()I-"I- It.'!. {:SF ()NI.Y: <br /> <br />Fees: <br />Pennit $ <br />State Surcharge $ <br /> <br />Approvals: <br /> <br />Plan Reviewer Planning <br /> <br />Contractor's License $ <br />()tl1er: $ <br />Total Fees: $ <br />Receipt #: <br />Receipt Date: <br /> <br />Engineering <br />