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Sign Permit ApplicationSGN2021 Name: ______________________________ Address of Applicant: ______________________ City: ______________________________ Phone: ___________________________________ Property Owner Name & Address: _____________________________________________________ Street address where sign is to be located: _________________________________________________ Lessor (If other than property owner) Name & Address: ______________________________________ Approximate Erection Date: ______Total Sign(s):_________Sq.Ft. Height:_____Feet Width:____Feet Shape of the Sign: Square, Circular, Rectangular, Triangular, Other: _____________________________ Sign material; Face and Uprights; Type of Sign: (Pole, Wall, Roll Around, etc.) _____________________________Number of signs________ If more than one sign list separately Sq.Ft. for each? ___________________________________________ NOTE: The Following Must Accompany This Application 1. REQUIRED WITH APPLICATION: A sketch of the sign site location attached to this application. 2.REQUIRED WITH APPLICATION: A copy of a valid land lease or signed affidavit by the property owner stating permission has been given to erect a sign. 3.A copy of your electrical permit (if applicable). Field Inspection Requirement: The application must mark the location for a “proposed” sign site with an easily visible flag or stake. Failure to properly mark a “proposed” site will result in the rejection of this application. The permit is not transferable to another outdoor advertising device. I certify that the statements made on this application are accurate and true to the best of my knowledge and understand that if investigation reveals that the information is false, the permit will be voided. Signed: ______________________________________________ Date: __________________________ Printed Name: ______________________________________EMAIL:____________________________ Sign approved: □ Sign Denied: □ City Official: _______________________ Date: _______________ Office use only: SIGN PERMIT # ______________ SIGN PERMIT FEES SIGN PERMIT APPLICATION CITY OF LAVERGNE CODES DEPARTMENT 5175 MURFREESBORO RD LAVERGNE, TN 37086 PHONE (615) 213-2624 FAX (615) 213-8692 $__50.00_____ Issuance Fee PLUS $___________$1.00 per square foot $___________ Total Sign Permit Fees