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V,4«...n••t - Application for a P rmit to Build No. —
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UPON FINAL APPROVAL MAP LOT
FEE MUST ACCOMPANY THIS APPLICATION. DATE of 3 19 90
The undersigned hereby applies for a permit to build gi A3/90
acco5ing to the following specify ations (b /7)
ame of property owner , i • 4'- '�.1/ta '/ Tel. &PT?:9/C)Q
AddressI - • . ' . -I� �L_ • A" ...j IJi ' •
• 2.Name of Architect(if any) Tel.
3. Name of builder es-2,0•42,c2 Address
4. License No. Tel.
5. Name of Mason Address
6. License No. Tel.
y'Construction address l'G Tgtt% /g2?C `71)2
Flood District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
10. Multi family 0
ev Type of room No.
11. Commercial 0 Kitchen
12.Other o Dining Rm.
g d Living Rm.
13. No. of stories a o r Bed Rm.
14. Foundation — Full ❑ Half 0 Crawl 0 Slab 0 Bath
15. Materials — Wood 0 Cement 0 Other 0 Deck
16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
17. Garage — 1 0 2 ❑ Sro Rm.
Suunn room
18. Swimming pool - Size Garage
19. Storage ed — Size ir Shed
20. Stove Wood 0 Co?Its .• ' /� % �� Alterations
21. Size of lot: No. of feet front_ of feet rear No.of feet deep
22. Size of building: No. of feet front No.of feet side No. of feet rear
2a Distance from nearest building: Front Ft.side Ft.side Rear
24. Distance back from line or street From rear lot line Side line
LOT RELEASED BY Signatur !!! i a / ' r
ii PLANNING BOARD Address &O • • , , e
Date --7,/ eat ray