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City of Buckner
Sign Permit Application

Permit Expires 6 Months After Approval Date Construction { } Alteration { } Maintenance { }
Location of Sign:      
Zoning District: 
Ownership: {  } Private (Indiv./Corp.) {  } Non-Profit {  } Public (Fed./State/Local) Type:    
Permanent { } Temporary { }

Size: A Drawing or Sketch of sign MUST be attached. The sketch MUST show the size and wording of the sign. Free Standing Signs & Attached Signs MUST have attached a plan showing the location of sign.

Construction Materials:      Approved Combustible Materials to be Used? Yes {  } No {  } Illuminated? Yes {  } No {  }

Permit Application Fee: $25.00 & Non-Refundable PAID { }

MODOT Approval Required if Location will be on 24 Highway (Monroe Street)



Owner/Lessee: 
Mailing Address:         
Phone Number:    
Contractor: 
Mailing Address:         
Phone Number:
License Number:  

I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to applicable laws of this jurisdiction.


Signature of Applicant  Date
Approved By Title Date