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TS202200011 Application 2022-04-11
Temporary Sign Permit Application FOR OFFICE USE ONLY Sign Number: Fee Amount: $ 31.20 Date Paid: BY Application fee: $30+ Technology Surcharge: $1.20 Receipt #: Check #: BY V Albemarle CountyCommunity Ded, Noftl 4l emarl RQ oun yMcirtire Cherlott.Wft, VA n2Phone 434.M+5832 Name: -Mall Address: / E Mailing Address: I lPhone#: -' -'7 Business Name: Tax Map and Parcel # Zoning: and/or Address of the Business: scarf will fill out x unknown IDA La Parcel Owner: t t-1 Y Owner's Address: lease fill out th following: What number permit is this for your business this year? flat El 2no ❑ 3ra ❑ 4Ut ❑ 5� ❑ 5u' IJ (check one) (this will be verified by staff) What type of temporary sign are BANNER ❑ PORTABLE ❑ A -FRAME you proposing? (check one) Depending on the zoning 12 feet ❑ 20 feet ❑ 30 feet district the maximum height of the sign will be if freestanding if on a wall if on a wall (check one) The required setback from 5 feet public street right-of-way will be Depending on the zoning district the maximum size of the 24 square feet ❑ 32 square feet sign will be Dates you are requesting the �tt11 "T I gl sign to be in place. l o1a through When entering the dates above, please keep In mind the following Information: Each permit for a temporary sign shall be valid for a period not to exceed fifteen (15) consecutive days after the erection of �T ACHED P IEGARDING:- the sign. The Ordinance requires the sign to come down between permits and will be approved on -site by a Code Compliance DDITIONAL Officer during regular business hours only. ALLOWED D THE COVID-t A maximum of two permits will be accepted for review for each establishment at one time. 'DISASTER '. Please note that an establishment Is not permitted more than sixty 1601 days of temporary signs in a calendar year. his application cannot begin until the application iscomplete and all applicable attachments and fees are submitted. t will only be valid on the parcel for which it is approved. rtify that I own or have the owner's permission to use the space indicated on this application. I also certify that the F provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that y am.1 n�, I Printed �1J7'I YV t/li�, F� ✓7—/YL9� Date V� © Temporary Sign Permit Application 2 �� <0�1 UUvnbe RAC GUMtlaeNa. VA 32Bp2 RIIOfM e31.395.56i! Applicant - If you are not the land owner, please fill out the entire page below confirming that you have either informed or are going to inform the owner of your application. CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER I certify that I will provide (or have provided) notice of this clearance application, U� to � 1 U,WA4 MIU the owner U 0 of Tax Map and Parcel Number baloo--(D-00 -0(11%en by either delivering a copy of the application to them in person or by sending them a copy of the application by mail. (Please check one of the following below) Cv� Hand delivering a copy of the application to the owner identified above on3 Date (e I�_ ❑ Mailing a copy of the application to the owner identified above on to the following address: (Written notice to the owner and last known address on our record books will satisfy this requirement. Please see staff for help determining this information if needed) Signature of Applicant] Applicant Name Printe Date