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Application Date;

I/We hereby make application under the provisions of the pertinent Bylaws for
permission to Construct, repair or alter the following Sign and agree to all
the requirements of the said Bylaws in force in the Municipality and to
indemmify and keep harmless all claims, liabilities,
judgements, which may in any Way accrue
against the j ici i i » and incidental to, the

Building Site Address:

Tenant Name: Phone No.

Partial Legal Description: Lot # Plan # Block # .

CONTRACTOR

Name Name

Address Address

City City

Postal Code Phone No. Postal Code Phone No,

Type of sign: Lot area:

Sign height:
canopy —— Changeable copy __ Sign Area:
fascia freestanding tee Copy Area:

projecting sandwich board Weight:
Estimated Construction value:

Promotional _ balloon

noncommercial

off-premise

TERRI TOC HOSI ICO ISIE OI ollie Every owner shall give at least 48

*OFFICE USE ONLY hours notice to a Building Inspector
* prior to the start of work on the

building site.

APPLICANT

*Permit No.:
*

*Zoning:
He
*Processing Fee Paid:
ke

*Receipt No.:
*

*Comments :

* 4% 42 + x

Name

Signauture

+ te % X
~~

Phone No.