Department of Planning and Inspections

PO Box 47, Blowing Rock, North Carolina 28605

Phone 828-295-5240 Fax 828-295-5202

www.townofblowingrock.com

Publication Information

Publication Name_______________________________________________________________

Publisher_____________________________________ Phone ___________________________

How often is your publication issued? _______________________________________________

Type of Publication: □ Free Publication □ Coin-Operated

Contact Information

Name_________________________________________________________________________

Street_________________________________________________________________________

City_________________________________State_________________Zip_________________

Phone_______________________________Email____________________________________

Mailing Address________________________________________________________________

Location Request

Please check which locations you are requesting and indicate the number of cabinets requested. Note that this request does not guarantee placement of space(s) requested.

Location Total Available Number of Cabinets Requested

□ Memorial Park 6 Coin / 4 Free ___________________________

□ Gossip Park 6 Coin / 4 Free ___________________________

□ Post Office 6 Coin / 4 Free ___________________________

Applicant Signature________________________________________ Date ______________

Fee: Coin-Operated Spaces = $100.00/year Free Publication Spaces = $50.00/year

OFFICE USE ONLY

Date App. Received___________ Date Paid___________ Amount Paid___________ Ck# ___________