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Salem
License NO.
;ddress
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ype of Sion: Surface,
Richt Aneles :o cuildinc , Free Standing,
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1g 'r Xan Area____--Ln.zp Sr
Sian Dimensions �/ '7
Sign Area SF
Existing Sions : Surface: Sion Area t/ e 1654 FT SF
Richt Angles : —Sian Area SF
Free-standing Sian Area SF
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Sian Area Signs to be Removed: Type K/
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Frcntage: 9uilding
':a.:.e and .,ddress of Signature of Owner i
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Company: Representative
-"y r Signature of Owners Authorized Rep
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�(( it 7U :�..� l�C Address
Estirated Cost UD J Telephone
of New 'work
AFPRO Signature of Property Owner ,/i, :
S'' /ACS
ZIGGY & SONS
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DONUTS
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