2016-00569CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX (763) 295-4404
ADDRESS 9320 CEDAR ST S
PIN 155169001010
LEGAL DESC MONTICELLO BUSINESS CTR 3RD ADDN
LOT 001 BLOCK 001
PERMIT TYPE SIGN
PROPERTY TYPE COMMERCIAL
CONSTRUCTION TYPE SIGN, TEMPORARY/PORTABLE
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2 0 1 6- 0 0 5 6 9*
DATE ISSUED: 09/12/2016
NOTE: PLEASE KEEP TRACK OF YOUR DAYS AND HAVE AVAILABLE UPON REQUEST WITH CORRECT DAYS FILLED OUT.
RETURN THE COMPLETED PERMIT BY JANUARY 5TH OF THE FOLLOWING YEAR.
DO NOT PLACE IN THE PUBLIC RIGHT OF WAY
NUMBER OF TEMPORARY SIGNS
APPLICANT
INSTALL THIS SIGN & AWNING
4835 LYNDAL AVE N
MINNEAPOLIS, MN 55430-
OWNER
WAL-MART REAL EST BUSINESS TR
1301 LOTH ST SE
PROP TAX DEPT #8013
AR 72716-0555
AGREEMENT AND SWORN STATEMENT
I agree that the work will be conducted in conformance with
the ordinances of the City of Monticello and with the
Minnesota State Building Code. I understand that the work
will be in accordance with the plan that has been approved by
the Building Official. I agree that any damage caused to
public property including but not limited to curb, sidewalk,
public utilities and signs will be repaired at my expense.
Applicant
Date
Bldg Official Date
SIGN (TEMPORARY) PERMIT FEE
TOTAL
Payment(s)
CHECK 24117
50.00
50.00
50.00
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
DEVELOPMENT SERVICES OFFICE USE ONLY
BUILDING INSPECTIONS Permit #
505 WALNUT STREET, SUITE 1 City Hall (763) 295-2711
MONTICELLO, MN 55362 Building Inspections (763) 295-3060
MONTICELLO www.ci.monticello.mmus — infockki.monticello.mmus Fax (763) 295-4404
TEMPORARY SIGN PERMIT APPLICATION
Date:
Site Location:
TenantBusinessBuilding Name:
The Applicant is:
PROPERTY
OWNER
CONTRACTOR
Owner
Name: Vv-\[N-
Address: 3-(-
CRY:
E-mail Address (required)
Contractor
Ce' ' S 4
Other (Describe)
Phone:
State: r" , j Zip Code:
Company
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Name P'
Address: (f S —
City:
Description of Work: (Sign Messages)
Q r CI\C + aL\'
Width x Height
Location on Property:
Site Plan May Be Required)
State:
2 S33<2r-CSC, Phone: Zip
Code:
Total Sq.
Feet ' U(32' MAX) Zoning District Please Complete
Other Side
Computation of Fees:
50 foreach temporary sign TOTAL FEE $ RECEIPT #
NOTE:
TEMPORARY SIGN PERMITS ARE VALID FOR 120 DAYS PER CALENDAR YEAR) This
form must be kept in an accessible place and available for review by City staff at any time during normal working hours.
Failure to maintain an accurate log sheet may result in the City rescinding the annual permit. I
have reviewed city regulations pertaining to portable signs and banners. I recognize that this permit allows me to display a portable sign or banner
on my property for a maximum of forty days per calendar year. Futhermore, I hereby agree to maintain a daily account of the use of banners
on my property. If I fail to keep such an accounting, I will not object the City rescinding my permit, and I will not object to having a City employee
enter my property to remove banners or portable signs. Name (
Print) Property Owner's Signature M7/
Z Date
X / PLEASE
RECORD THE DATES TEMPORARY SIGN IS ERECTED FOR THE YEAR: 20LL i
DateSignErectedI0 Date Sign Removed DAYS USED Date
Sign Erected Date Sign Removed DAYS USED Date
Sign Erected Date Sign Removed DAYS USED Date
Sign Erected Date Sign Removed DAYS USED Date
Sign Erected Date Sign Removed DAYS USED Date
Sign Erected Date Sign Removed DAYS USED Date
Sign Erected Date Sign Removed DAYS USED Date
Sign Erected Date Sign Removed DAYS USED TOTAL
DAYS USED THIS CALENDAR YEAR REQUIRED
INSPECTIONS SITE
FINAL Conditions
of Issuance: 1
Investigation
Fee: Reason: Amount: $' Permit
Approved By: , _ f l,`j_ Date: F"'
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Save money. V%re better.
Facilities Management 2001SE10" Sr
3enlmivHle, Ati, 72716-0595
Phone 479-204 2837
Environmental Services
Nu.479.273-1961
Exterior Signing
Ben Jennen, Project, Manager
Attention Store Manager;
National Sign & Marketing Corporation is currently implementing a rollout of a temporary
Online Grocery Pick -Up" banner program.
The installation contractors performing this scope of work are working under the direction of
the Walmart Home Office and have been given specific instructions with regards to the
banner placement on the building and the method of attachment to be used.
Regards.
Manager, Exterior Signs
Office: 479.204.3837
Cell 479.295.4612
Fax: 479 273 1961
beniama iennen0walmart.com
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