Sign Registration (temporary)

CITY OF LAKE MARY
TEMPORARY SIGN REGISTRATION


DATE RECEIVED:_________________________

RECEIVED BY:___________________________

APPLICATION NO.:_______________________

PROJECT NAME:________________________________________________________________________

PROJECT ADDRESS:_____________________________________________________________________

PROPERTY OWNER'S NAME:______________________________________________

PHONE #: ________________________________

ADDRESS:__________________________________________________ CITY:_______________________

STATE:_____________ ZIP: ________________________

CONTRACTOR NAME:____________________________________________________________________

CONTACT:_________________________________________________

ADDRESS:__________________________________________________ CITY:_______________________

STATE:_____________ ZIP: ________________________

PHONE NUMBER:________________________________

FAX NUMBER:____________________________________

EMAIL:______________________________________________________________________

STATE LICENSE NO.:_______________________________________

OCCUPATIONAL LICENSE (BUSINESS TAX RECEIPT) NO.:________________________________

HOW MANY:_________  PROPOSED SQ. FOOTAGE:________________________

TOTAL SQ. FT. OF OTHER TEMP. SIGNAGE ON SITE:_______________________________

ZONING DISTRICT:_________________

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.
REGISTRATION FEE IS $4.00.

_____________________________________          _____________________________________
 CONTRACTOR/OWNER SIGNATURE                                           DATE
 
COMMUNITY DEVELOPMENT

APPROVED BY:_______________________________________     DATE:___________________________
 
COMMENTS:_____________________________________________________________________________
 
__________________________________________________________________________________________
 
__________________________________________________________________________________________

Statement of Fact
And
Informed Consent

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:
 
1.I acknowledge that I must comply with all provisions of the above identified sign registration 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 registration;
3.I agree that a City official, employee, or agent may place an adhesive “Notice of Violation” on the face of the registered sign if it is found to be in violation of the Lake Mary Code of Ordinances, or the terms of the above identified sign registration 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 registration, 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 registration is issued for a sign based on the following:

Zoning District: _________________________________

Maximum Square Footage and Height allowed:______________________________________________

____________________________________________          ___________________________________________
      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