CITY OF FORT CALHOUN
SIGN PERMIT APPLICATION

Sign Type: ___________________________________________________Date: __________________
Property Owner: ________________________________________ Phone: _____________________
Property Address: ____________________________________________________________________
Legal:   Lot(s) : ___________________ Block: __________ Addition: _____________ Zone: ______
Contractor: __________________________________________________________________________ 
Address: _______________________________________________ Phone: ______________________
Description of Work: __________________________________________________________________
_____________________________________________________________________________________
Cost of Construction: _________________________   Plot Plan Received:         yes                   no
Explanation: _______________________________________________________________________
                                   Utilities:                                    Electricity (Requires separate Permit)

Setbacks:      Front: _________ Rear: __________ Interior Side: _________ Street Side: _________
(Setbacks are determined from PROPERTY LINES)

Total SQ. Footage:         ______________               Dimensions: _____________________________

Applicant’s Signature__________________________________________________________________

DO NOT WRITE BELOW THIS LINE – FOR OFFICE USE ONLY

_____________________________________                               ________________________________
P. C. Designee Signature                                                                    P. C. Designee Signature