Please read all instructions and then complete the following information and
Print, Sign, Notarize, Date and Mail in Duplicate, along with Sketch, to:

Incorporated Village of Farmingdale
PO Box 220   361 Main Street
Farmingdale, NY 11735
(516) 249-0093
www.FarmingdaleVillage.org
APPLICATION FOR A PERMIT TO ERECT A SIGN
To be filed in Duplicate
NO WORK IS TO BE STARTED UNTIL PERMIT IS ISSUED

Permit No.

Date Issued:

Value of Work:

Permit Fee:

Zone:

Approved By:
PLEASE TYPE OR PRINT CLEARLY
The undersigned hereby applies for a permit to erect a sign which will be done in accordance with the description on the attached sheet herewith and in accordance with sign ordinance No. 57, as amended, of the Village of Farmingdale.
Name of Applicant: Address of Applicant:
Contractor's Name: Contractor's Address:
Name of owner of the property
on which sign is to be erected:		 Address of Said Owner:
Present use of land or building:
LOCATION OF SIGN
Street: No. of other signs on property:
Type of sign:
Wood Metal Neon Wall lettering Front wall Side Wall Rear wall
Vacant land sign:
Distance sign sets back from property line
 Width of building
Ground sign:
Distance sign sets back from property line:
 Height of sign above ground level:
 Projection from building:
FUW Lable No. on electrical and neon signs::
SPECIAL CONDITIONS OF THE PERMIT:

Dimensions:
Horizontal: Vertical: Total square feet:
WORDING AND CONSTRUCTION OF PROPOSED SIGN

Applicant is to provide sketch of wording, construction and specifications of proposed sign on separate 8 1/2" x 11" sheet of paper, showing dimensions, materials and details of construction and affixation.

All signs erected, renewed or painted on building walls under this permit must bear the assigned permit number in the lower right hand corner of the sign. Numbers are to be 2" high.
 
PROPERTY OWNER'S CONSENT
Consent is hereby given for the erection of the above sign on my property.




________________________________
Signature of Witness



________________________________
Signature of Property Owner
The applicant hereby agrees that this permit is subject to revocation at any time if the sign becomes unsafe in the discretion of the Building Inspector of the Village of Farmingdale.
A F F I D A V I T
State of New York

County of:______________________________


_____________________________________________being duly sworn deposes and says that he/she is the person who has signed the above application and that to the best of his/her knowledge and belief the statements contained in this application are a true and complete statement of all proposed work on the described premises.




________________________________
Sworn to before me this date



________________________________
Signature of Applicant