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2. Application Date
   Application Date
4. Applicant's Full Name*
5. Applicant's Phone*
7. Applicant's Address*
9. Email Address
11. Address of Temporary Sign*
12. Block
13. Lot
15. Location of Temporary Sign*

    1. Building Facade
    2. Ground
    3. Other
17. Will the sign be located across a public street?*

    1. Yes (no photograph or plot plan is required)
    2. No
19. A photograph of the building façade which indicates an accurate location of the sign to be placed on the building façade or plot plan showing an accurate location on the property shall be submitted with this BANNER REQUEST. BANNERS ACROSS SPRINGFIELD AVENUE AND PLAINFIELD AVENUE REQUIRE A CERTIFICATE OF LIABILITY INSURANCE AND A HOLD HARMLESS AND IDEMNIFICATION AGREEMENT. ***BANNER SHOULD INCLUDE CARABINER SNAP HOOKS AND ROPE FOR HANGING***
21. Upload any diagrams. graphics, illustration, or photo of the sign and its contents including dimensions and area.
23. Upload 1
24. Upload 2
25. Upload 3
27. Duration of Sign Request*
    Duration of Sign Request Start Date

    —

    Duration of Sign Request End Date
29. Name of Person, Firm or Association Erecting Sign
31. Reason for Temporary Sign
33. Property Owner Consent
    If the Applicant is NOT the owner of the building, structure or land to which, or upon which, the sign is to be erected please upload written consent of the owner.
35. Applicant's Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Applicant's Signature
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field