(Please call 24 hours in advance for inspections)

Date of application:*

Project Name:*

Job Address:*

Applicant’s Name:*

Applicant’s Address:*

City:*

State:*

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Zip Code:*

Applicant’s Phone:*

Applicant’s Email:*

Contractor’s Name:*

Contractor’s Phone:*

Contractor’s Email

Description of Sign Work:

Historic District?*

Yes

No

* Please note: Permits for signs in the Historic District will not be issued without a Certificate of Appropriateness from the Historic Review Board.

** Please note: if the sign requires electric, a separate permit is required and all electrical work done on/for the
sign must be completed by a Michigan City registered and licensed electrical contractor.

Electrical Contractor:*

Contractor address:*

City:*

State:*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip Code:*

Contractor Email:*

The following must be included with the sign permit application:

1) A site plan or aerial of property showing footprints/locations of all existing and proposed buildings, structures,
signs, property lines, ROE, easements and adjacent streets/alleys

2) Sign details showing sign dimensions, base, landscaping, lighting, total height, type, square footage and
materials

3) A separate Electrical Permit Application (for any new electrical work)

4) As requested, copies of stress sheets and calculations showing the structure as designed for dead load and
wind pressure

5) As requested, other information required by the enforcement official to make the determination that he
proposed sign(s) is in compliance with applicable laws and regulations

Permit Fee:

Sign Area:*

SF X $1.00 (Round Up) = $*