Commercial Sign Application

CITY OF LAKE MARY
SIGN APPLICATION

DATE REC.:_____________     RECV’D. BY:_____________     SIGN PERMIT NO.:_________________

PROJECT NAME:________________________________________________________________________

PROJECT ADDRESS:_____________________________________________________________________

PROPERTY OWNERS NAME:_________________________________ PHONE: ___________________

ADDRESS:________________________________ CITY:__________ STATE: _______ ZIP:____________

CONTRACTOR NAME:____________________________________________________
 
CONTACT:________________________________________

ADDRESS:________________________________ CITY:__________ STATE: _______ ZIP:____________

PHONE NUMBER:______________________________ FAX NUMBER:____________________________

STATE LICENSE NO.:______________________

OCCUPATIONAL LICENSE (Business Tax Receipt) NO. _____________________

WHAT TYPE OF SIGN (MONUMENT, WALL, TEMPORARY, ETC.):____________________________

HOW MANY? _________ TOTAL SQUARE FOOTAGE OF ALL SIGN(S):_________________________

TOTAL SQUARE FEET OF EXISTING SIGNAGE ON SITE:____________________________________

BUILDING FRONTAGE FT.:________________________ ZONING DISTRICT:_____________________

SIGN ELECTRICALLY LIGHTED?_______
 
ELECTRICAL CONTRACTOR: _________________________________________________

NAME OF SIGN(S) MANUFACTURER:_____________________________________________________

NAME OF RECOGNIZED TESTING LABORATORY:__________________________________________

LISTING AND/OR UL# NUMBER: _________________________________________________________

FEES ARE BASED ON TOTAL VALUATION OF SIGN $ _______________________

I DO HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, ALL THE INFORMATION
SUPPLIED HEREIN AND IN ANY ATTACHED MATERIAL IS TRUE AND ACCURATE.
 

_____________________________________         _____________________________________                
CONTRACTOR/OWNER SIGNATURE                                          DATE


                           
 
OFFICE USE ONLY

COMMUNITY DEVELOPMENT

APPROVED BY:_______________________________________     DATE _______________________
COMMENTS _________________________________________________________________________
______________________________________________________________________________________
 
BUILDING DEPARTMENT
 
APPROVED BY:_______________________________________     DATE _______________________
COMMENTS _________________________________________________________________________
______________________________________________________________________________________
 
 
Statement of Fact
And
Informed Consent

 


Permit # ______________________________

Location: ___________________________________________________________________________

By my signature below, I acknowledge that I have been informed of the following and have given my informed consent to the terms and conditions hereof:
 
Acknowledge terms and conditions
1.I acknowledge that I must comply with all provisions of the above identified sign permit and the Lake Mary Code of Ordinances, including but not limited to, Chapter 155, Appendix I.
2.I agree that City officials, including but not limited to, Code Enforcement Officers, Police Officers, Citation Officials, and Building Officials may enter into or come onto my private property at the above identified location to inspect all signage installed thereon to ensure compliance with the Lake Mary Code of Ordinances and the above identified sign permit;
3.I agree that a City official, employee, or agent may place an adhesive “Notice of Violation” on the face of the permitted sign if it is found to be in violation of the Lake Mary Code of Ordinances, or the terms of the above identified sign permit and I hereby indemnify, acquit, and absolve the City of Lake Mary, its officers, employees and agents of any liability arising from the placement of the Notice of Violation and covenant and agree not to sue the City of Lake Mary, its officers, employees or agents for any damages arising out of the entry on or into my property or the placement of the Notice of Violation.
4.I acknowledge that I have signed this “Statement of Fact and Informed Consent” acknowledging my informed consent to the terms hereof, prior to issuance of the above identified sign permit, and further certify that I am the owner of the subject location, or that I am an authorized agent of the owner and have the authority to bind the owner to the terms of this “Statement of Fact and Informed Consent”.

The above permit is issued for a sign based on the following:

Zoning District: ____________________________        Type of Use: ______________________________

Maximum Square footage and height allowed:_______________________________

Amount permitted: __________________________________________

 
_________________________________________                   ________________________________________
    Owner/Authorized Agent Signature                                                       Print Name
 

STATE OF FLORIDA
COUNTY OF SEMINOLE

Sworn to and subscribed before me this _______ day of ______________________, 20______,
by _____________________________________, Applicant Authorized Representative, who is
personally known to me or who produced his/her Florida Driver’s License
#_____________________________________________ as identification.


__________________________________________                (SEAL)
               Notary Public Signature

_________________________________________
           Notary Public, Printed Name