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BUILD ENT
• VIL LOx Y. K AUG 19 2025 l
938 ICl1nc kVt Bi M 1073
VILL
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Approval Datg_2 FJ 202 t�k — Application* A-P�Q5- /QCj
Approval Sipatttre: Air ARD•
Disarprow�d:
Date:
DOT Approval Date: Cate p Chairman:
PB Approval Date: Cateµ Shy.
Z BA Approval Date Cate 0 '
Ckdor: -— •
Appl eadou Fee 70 Pernik Fen:
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SIGN PERmu APPLICATION
Appkatiin ddod: , is eereby made to the Bm'ldiog Spector of the VlllWoflltje HrWk Ny.far tee iasetace of s Pe®it foe tee
wnstrtretioo/mstaI of a Ap in aootrdana with VNIap Cade J250-35 as per detailed stattanest der dW below.
1. Address:
SBL Zone:
2. Property Ute or Bu4nea Name:
3. Propotod Sips)(Describe in detail including number of signs,types,SizCS.exact kcsd*sl sad Mwnmatim method(s)if apphabk.)
(A separate Electrical Permit Will be roquired for any associated ne ed Wo&) •
e/ �n�� rr�er�-f S1C�r�� Lc1, fL
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4. Hei0f from grade to WOM Point of sip: —•to lowest point of sip:
yC 5. Pr opaty owns:�a.i,V C�'�t a c ti M f,4)L4 f4 CA,t LCID6ddreu: SAL G&jjA s Ijj-V4 E fttwk N y/4j-�)
Phone M._ Con p email: i , c:oi✓►
6. Applicant'
Add.
Phone,0 4 ld—g 3 7-(v3G Ceu lr emu: —tit s14 rJ Dt sl a �o^'`
I Addrea•
7. ArcbitecdFgpoeer.
Pbooe N # tiL
ef
Tel 1�5 73
B. Sip Contractor: S tJ �Ll�W h t r► _Address: 0 _f I I GTT � Q—
Phone p t? _ :�J Z'63 0 Cell# email:
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6/1f2024
9, VVitI the p qm rupire a Site Plan Review by the VO4c Plannin j Boatd u per 1209 of Village Code?
• Yee No: (if)T,you must oubmit s t+hr Plan Application,A prorldr dralkd draaYnr.,
10. Does the proposed a*involve a Horoe4ocupation as pet 1230-39 of V111060 Code? Yes.--No:,__ Jf yes,indicate:
TIfiR I:_TMR I1:______TIER Ill:— (if yea,a Floor Occupation Pamh Applk•trnn is retreirey)
11. If building is located on a cornet lot,which street does it tot on:
12. Property f ntage:
13. Property sine,Sq.R.:
14. What is the total estimated Coat of construction: t 'r0 ")Ob Q D
(Tlte estimated cast shall indWe all site improvemeats,labor,,t w erial,scaffolding,fixed equipment p(ofe•ilm"!kn,i"clu ing any matma
and labor whica tea),be donated gtatis.)
13. Edim etsed date of completion:
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This application must include the notarized signatures) of the legal own*gs)of the subject
property.and the applicant of record In the spaces provided.Any application not PrOPeft
completed in its entirety andlor not properly signed shall be deemed null and void,and will be
returned to the applicant.Please nob that appKcation fees are non4rfundabie.
NfM}#.flR#lNIRRtMAillRfNf/fNN#N#M#N#AR#N!f#f#ltilt!RNRfNANf!#tN#NfRAfINHMfN1M#!#fAMN
STATE OF NEW YOM COUNTY OF VESTCH13SM ) as:
5 N to• 6 uU. .being duly sworn,deposes and states that hatahe is the applicant above named,
OrMname o[io�sites to its rppbaes)
and further states that (s)he is the legal owner of the property to which this application pertains, at that (:fie is the
c.T O 1 L- __w_for the legal owner and is duty authorized to make and file this appbcafm
(odiass.r lot,ooatracsoti WK YlCrI ) tar-)
That all statimenta coaWned beet an true to the brit of bn&er knowledge and belief,and that any work performed,err ass
oonihwted at the above captioned propeltY will be in conformance with the details as so forth and cow in this application
and to any accompmymg approved plant and q=&*Wns, as well as in accordance with the New York State Uniform Fire
preventim&Building Code,the Code of the Village of Rye Brook End all other applicable laws,ordinances and regulations.
k Sworn to before the this
x Sworn to before me this
i
v l� , 20 9-s day of 20 5
S ofProperty 4patu a of licatt
Za--
pS t t U R U L Print Name o
Prior came ofPtoparty Owner
— — Notify Public
LOIS NIETO
SONIA M. KRAUS NOTARY PUBLIC, STATE OF NEW YORK
Notary Public• State of New Yor NO. 01 N14899825
No.01KR62=4 QUALIFIED IN WESTCHESTER COUNTY
Qualified in Westchester County COMMISSION EXPIRES DECEMBER 3, 2026
My Commission Ew It-aG—Uo -�
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