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r- <br />CITY OF LITTLE CANADA <br />515 East Little Canada Road <br />Little Canada, MN 55117 <br />484 -2177 FAX 484 -4538 <br />SIGN PERMIT APPLICATION <br />x//77 k �k� Y3 el 4t4ntt.4 v <br />Applicant <br />.+Vti /Z£rc <br />Land Owner <br />Z 6C,r< ithv <br />Mail Address <br />ICS <br />Location or Legal Desciiption <br />Sign Message <br />)94-0, t7 4e-: (S L C <br />Permit No <br />Expiration Date <br />PERMANENT OR TEMPORARY <br />/2,,n0c ; &, �. 5 ayd 4' <br />Phone <br />6i } —S-3 r— c � <br />Phone <br />Sign Dimension • size/height <br />(Please Check) <br />Double Faced Sign Single Faced Sign <br />Illuminated <br />No <br />Diagram of Sign - Method of Construction & Mounting <br />CLCJCt7 <br />Co L. :Z t L C <br />SMIS S <br />S1t ti; <br />JOB VALUATION: <br />fleti <br />0 rt. -r- r r+ fr L <br />`J s .fir 3 D.A- <br />Location of Setbacks f am Property Lines <br />and /or Buildings <br />Permit Fee <br />Surcharge <br />TOTAL $ <br />Landowners Approval <br />Appflcants Signature D <br />License Number <br />Date <br />SPECIAL CONDITIONS <br />Approved for Issuance (City Official) <br />Permit Fee According to <br />Valuation UBC Table 3 -A Fee Schedule <br />SIGN PERMIT VALID FOR 2 PAGE 172 lected b y <br />from date of issuance <br />