HomeMy WebLinkAboutSign Permit ApplicationAPPLICANT INFORMATION
APPLICANT: ORG/BUSINESS:
PHONE: EMAIL:
ADDRESS:
Address City State Zip
PROPERTY
OWNER:
PHONE: EMAIL:
ADDRESS:
Address City State Zip
BUSINESS
OWNER: ORG/BUSINESS:
PHONE: EMAIL:
ADDRESS:
Address City State Zip
PROPERTY INFORMATION
ADDRESS:
Address
COUNTY PARCEL ID (NOT STATE TAX ID)
ZONING: VARIANCE, SPECIAL USE/
EXCEPTION APPROVAL ☐N/A ☐ YES
Zoning Approval Date
OVERLAY: ☐ YES ☐ NO DESIGN APPROVAL ☐ N/A ☐ YES
If your property is in an Overlay the designs must be submitted to the Design Review Specialist for approval. Approval Date
ENCROACHING IN
PUBLIC ROW ☐ YES ☐ NO PUBLIC WORKS
APPROVAL ☐N/A ☐ YES
If “yes” your designs must be submitted to Public Works for approval before a permit can be issued. Approval Date
HISTORIC
DISTRICT: ☐ YES ☐ NO HISTORIC APPROVAL ☐ N/A ☐ YES
If your property is in an Historic District the designs must be approved by Historic Preservation. Approval Date
FLOOD PLAIN OR
WETLAND: ☐ YES ☐ NO FLOODPLAIN/WETLAND
APPROVAL ☐N/A ☐ YES
If your property is in an flood plain or wetland you will need prior approval from the applicable authority. Approval Date
City of South Bend
SIGN PERMIT Application
SIGN INFORMATION Number of signs applied for
PERMANENT OR
TEMPORARY: ☐PERMANENT ☐ TEMPORARY If temporary
start/renewal date Start Date Renewal Date
PURPOSE: ☐ON PREMISE ☐*OFF PREMISE
•If “off premise” verify that “off premise” signs are allowed in the zoning
district in which your property is located.
Linear distance to
nearest off premise sign
Radial distance to
nearest off premise sign
SIGN TYPE
(Select ALL that
apply):
☐POLE ☐ MONUMENT ☐ FAÇADE ☐PROJECTING
☐CHANGEABLE COPY ☐AWNING
**If EMC # of msg/min ***Awning Area
(sq/ft) Other (Explain)
LOCATION ON PROPERTY/BUILDING:
FRONTAGE (Freestanding
Signs Only) Front Lot Line (ft) Second Front lot line if
corner lot (ft)
Total Frontage if sign is oriented to
both frontages (ft)
SETBACKS
(Freestanding Signs Only) Front (ft) Side (ft) Side (ft) Back (ft)
BUILDING FAÇADE
(Façade/wall signs
only) Height (ft) Width (ft) Area (sq/ft) Height (ft) Width (ft) Area (sq/ft)
INDIVIDUAL TENANT SPACE IF APPLICABLE
SIGN SIZE: Height from
street grade (ft)
Clearance from
ground (ft)
Height of Sign
(ft)
Width (ft) Sign Area
(sq/ft)
LIGHTING: ☐INTERNAL ☐ EXTERNAL ☐BACKLIT ☐NONE
IF APPLYING FOR MULTIPLE SIGNS FILL OUT THIS PAGE FOR EACH SIGN
EXTRA FORMS ARE AT THE END OF THIS PACKAGE
EXISTING FREE STANDING:
(Free standing sign applications
only)
SIGN 1
(If applicable) Type Location Area (sq/ft)
SIGN 2
(If applicable) Type Location Area (sq/ft)
•If there are more than 3 existing signs submit specifications on a separate sheet.
CONTRACTORS
All contractors must be licensed and/or registered with our department. For more information on this go to
http://www.southbendin.gov/government/content/contractor-licenses-0
SIGN CONTRACTOR: _____________________________ (REQUIRED IF BEING INSTALLED FOR REMUNERATION)
I certify the above to be a true and accurate to the best of my knowledge.
APPLICANT SIGNATURE DATE
PRINT NAME
EXISTING SIGNS
EXISTING FAÇADE SIGNS:
# of signs Total Area (sq/ft)
SIGN 2
(If applicable) Type Location Area (sq/ft)
# of signs Total Area (sq/ft)
# of signs Total Area (sq/ft)
# of signs Total Area (sq/ft)
FRONT:
SIDE:
SIDE:
REAR:
ST. JOSEPH COUNTY/SOUTH BEND
BUILDING DEPARTMENT
SIGN AFFIDAVIT
I, __________________________________, am an authorized representative of
_______________________________ (the “Owner”), which owns/legally occupies the property
PROPERTY OWNER / LESSEE SIGN OWNER
commonly known as __________________________, _________________, Indiana, ________
ADDRESS CITY ZIP
on which the proposed sign is to be erected; and have read and agree to the following:
1. St. Joseph County (the “County”) and the City of South Bend (the “City”) shall be
indemnified and held harmless by the Owner from any claims, damages, liabilities,
losses, actions, suits, or judgments which may be brought, presented, sustained, or
obtained against the County or City or its officials because of negligence of the sign
hanger, contractor, or his agents, or by reasons of defects in the construction, or damages
resulting from the collapse or failure of any sign.
2.The Owner will guarantee removal of the sign when the use which it identifies, instructs,
attracts, guides, or advertises is terminated at that particular location; however, this will
not apply to periodic changing of the sign faces for present or future tenants or owners. If
the Owner is not the owner of the real property on which the sign will be placed, the
Owner represents that the installation of the sign is authorized by the property owner.
3.The Owner shall maintain the sign by repainting peeled surfaces and replacing
inoperative components. Should the Owner fail to maintain the sign as outlined herein
within forty-five (45) days after written notice, the County or City shall remove the sign
after first giving the owner of the sign thirty (30) days written notice of its intent to do so.
Signed this _________ day of _____________, _______
DAY MONTH YEAR
SIGNATURE MAILING ADDRESS
PRINT NAME CITY ST ZIP
ORGANIZATION PHONE
POSITION EMAIL