Light Pole Banner Permit Application Organization*Applicant* First Last Phone*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicant's Signature*OptionsGroup Two Category Non-city governmental entities and/or Powell-based broad interest business, community or service organizations whose benefits go to charity or community projects. Examples: local schools, Olentangy Rotary, Powell Sertoma, Powell Chamber of Commerce, Powell Business Association, Powell/Liberty Historical Society, OYAA, Scout troops, etc. Group Three Category Organized groups whose benefits go to the organization or individual. Examples: all business/industry uses, charitable organizations not based in Powell. FeesGroup Two Category Price: $5.00 Quantity: Group Three Category Price: $50.00 Quantity: Total $0.00 Desired Location of Banner(s) i.e.: Along Olentangy St., Liberty Street, etc.Start Date to be Displayed* End Date to be Displayed* * Note: Banners may only be displayed for a period of four (4) weeks. Make all checks payable to the City of Powell.