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THE FOLLOWING INFORMATION MUST BE INCLUDED WITH YOUR APPLICATION: Payment for amount of permit. For freestanding/monument/pylon sign - a site plan with setback from property line dimensions and art work with dimensions of sign, and engineered design for footings and foundation. For wall sign, art work with dimensions of sign and drawings of building façade showing location of sign. If illuminated or if electrical services are needed, a separate electrical permit is required. If leased space, need to include a letter of approval from the property owner. SIGN LOCATION Name__________________________________________________________________________________ Address________________________________________________________________________________ City ____________________________________State__________________ Zip _____________________ Contact _____________________________________Day Phone # ________________________________ Email Address __________________________________________________________________________ PROPERTY OWNER Name__________________________________________________________________________________ Address________________________________________________________________________________ City ____________________________________State__________________ Zip _____________________ Contact _____________________________________Day Phone # ________________________________ Email Address __________________________________________________________________________ SIGN CONTRACTOR Company Name _________________________________________________________________________ Address________________________________________________________________________________ City ___________________________________ State___________________ Zip _____________________ Contact _____________________________________Day Phone # ________________________________ Email Address __________________________________________________________________________ SIGN DESCRIPTION Electronic ($100 per sign plus completion of electronic sign license, see Page 2) Permanent ($75 per sign) Temporary ($50 per event, up to 60 days per year. Max of one temp sign displayed at a time.) Temporary sign displayed dates: START DATE ________________________ END DATE ________________________ Sign Type and Dimensions Wall Sign: Width ____________ Height: _______________ Square feet _____________________________ Freestanding: Face Width_________ Height____________ Sq. ft__________ Overall Sign Height _________ Setbacks: Front _________ Side ____________ Temporary Width___________ Height ______________ Sign Square Feet______________________ Display location _______________________ Illuminated Sign: Internally illuminated Externally illuminated Not illuminated Type of Work: New Sign Replacement Sign Alter Existing Sign Changeable Copy: No Changeable Copy Manual Changeable Copy Electronic Changeable Copy (Electronic sign will require annual license review & renewal, see Page 2) Applicant Signature: ____________________________________________Date:_________________ Applicant Printed Name: _______________________________________________________________ SIGN PERMIT APPLICATION & ELECTRONIC SIGN LICENSE City of Lakeville – Planning Department 20195 Holyoke Avenue - Lakeville, MN 55044 952.985.4420 - www.lakevillemn.gov Marco M. Miller Marco M Miller Jr. LAKEVILLE SPECIALTY CENTER 18465 ORCHARD TRAIL LAKEVILLE Patrick Giordana pgiordana@synergyarchstudio.com 612-383-2701 MINNESOTA 55044 DAVIS REAL ESTATE ARCHETYPE SIGN 33 SOUTH 6TH ST, STE 4650 MINNEAPOLIS MINNESOTA 55402 612-341-3242MARK DAVIS mdavis@davishre.com 9611 JAMES AVE S. BLOOMINGTON MINNESOTA 55431 952-641-9639MARCO MILLER MARCOM@ARCHETYPESIGN.COM X X X SIGN PERMIT APPLICATION & ELECTRONIC SIGN LICENSE Page 2 Electronic Display/Changeable Copy Sign License Single occupancy building with gross floor area over 70,000 sq. ft. within the C-3 District and within the Freeway Corridor District. By signing below you are certifying the electronic signage meets the following performance standards: 1.The display sign shall not change more than once every twenty four (24) hours. 2.The display sign shall not include scrolling, flashing, animation, or other effects. 3.The display must be static and the transition from one static display to another must be instantaneous without special effects. 4.The display image or message must be self-contained, without continuation in content to the next image or message. 5.The brightness of the sign shall not exceed 5,000 NITS after sunrise and before sunset or 500 NITS after sunset and before sunrise each day. 6.The sign shall be equipped with an automatic dimmer control or other mechanism that automatically controls the sign’s brightness to comply with this condition. 7.The display must be designed and equipped to freeze the device in one position if a malfunction of the electronic display occurs. 8.The display must also be equipped with a means to immediately discontinue the display if it malfunctions, and the sign owner must immediately stop the electronic display when notified by the City that it is not complying with the stipulations of this section. 9. The sign shall comply with Chapter 23 of the Zoning Ordinance. Signature_______________________________________ Date______________________________ Print Name______________________________________ Email ________________________________ EXPIRATION AND RENEWAL OF LICENSE: •All licenses expire on December 31st of each year. •License may be renewed only by making application as provided in Section 3-22-4 of the City Code. •Application for renewal shall be made at least sixty (60) days before the expiration date. •Each renewal license shall be issued for a maximum period of one (1) year. •Annual license renewal fee is $50.00 Office Use Only Sign Permit Type: Permanent Sign _____ Temporary Sign _____ Electronic Sign _____ Work Type: New _____ Addition _____ Repair _____ Demolish_____ Replace _____ Alter/Remodel _____ Move _____ Owner: Public _____ Private _____ Zoning District: Commercial _____ Industrial _____ Residential_____ Freeway Corridor _____ Required Inspections: Footing _____ Final _____ Permit Fee: Permit Fee _____________ Miscellaneous ___________ Total ___________________ Comments: ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ Approved by:____________________________ Date:___________________________________ (REVISED APRIL 2022) X X X PUD X $75.00 $75.00 2 October 2023 *Email kjenson@lakevillemn.gov after installation for final inspection. 1.1 North Elevation (Partial) Channel Letters Scale: 1/16’’ = 1’-0’’ Scale: 3/8’’ = 1’-0’’ 1 2 Channel Letters STUD MOUNT FLUSH TO WALL INTO SILICONE FILLED HOLES Description Install Illumination Channel Letters 3” WHITE ALUMINUM RETURNS (STOCK) 3/16” WHITE ACRYLIC FACES (7328)(CNC) 1” WHITE TRIMCAP PRE-FINISHED WHITE ALUMINUM BACKS A B PHOTOCELL CONTROLLER SLOAN PRISM 6500K WHITE LED MODULES 79 L.E.D. MODULES - 53 LINEAL FEET TOTAL (2) - 60C3-60W (NON-DIMMING)(701507-60C3) 100-277 VAC 60 Hz - 0.80 A - 60 W @ 12 VDC8 60” 44’-2” 3” PROFILE 45.83 SQFT 18” 366 3/4” 9611 James Ave S. Minneapolis, Minnesota 55431 952 641 9600 archetypesign.com This print is meant as a representation of a sign show vin consideration of being manufactured by Archetype. Materials may influence final result. Samples available upon request. Graphic Design time is included in the total purchase price. Designs contained herein are not meant to be exhibited to others outside of included parties and employees. Designs received from Archetype may not be manufactured by others without reimbursement for time spent in the creation of these designs or any resemblance. Drawings may contain elements considered artistic intellectual property of Steve Carpenter, owner. ©Archetype Page: Type: Approved: Contact: Description: Project: Job Number: Date: Rev. 1: Rev. 2: Rev. 3: Rev. 4: Rev. 5: Rev: 6: Rev. 7: Designer: Steve Hirtz 952 641 9629 steveh@archetypesign.com Lakeville Health Q-102583 10.13.22 10.18.22 11.11.22 01.03.23 MF 07.12.23 07.14.23 08.15.23 08.25.23 DG