HomeMy WebLinkAboutBLD-90-572 • SAO
4s- x .' TOWN OF ' RMOUTH
""'4.0P6 l Application fo.r a Permit to Build No..___\517 .
UPON FINAL APPROVAL
�(� • MAP y 0' LOT Si`f
FEE MUST ACCOMPANY THIS APPLICATION. DATE Sept 117-- 19 0
The undersigned hereby applies for a permit to build Q i'ZVgb
according to the following specifications
1. Name of property owner re; 4er:c9a- Pau LZIA* « / MeS� Tel. S9/Piot),
Address 13 i o'j Li is mr So 'j ort-f-,/‘44-4
2.Name of Architect(if any) • • Tel.
3. Name of builder is u n g-It Address
4. License No. Tel.
5. Name of Mason . Address •
6. License No. Tel.
7. Construction address 13 --. n Lana S a • r nao�-c{'�
•
• 8. Date of subdivision Approval y plain zone District
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
Type of room No.
10. Multi family 0 Y 'j 0 0 • g" ) SJ 1
11. Commercial 0 • Kitchen ""
12. Other ❑ Dining Rm.
13. No. of stories Living Rm.
Bed Rm. •
14. Foundation — Full 0 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 ❑ 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage -
19. Storage shed — Size// Shed
20. Stove — Wood'111/Coal D- ric w Alterations
21. Size of lot: No.of feet front No. of feet rear No. of feet deep
22. Size of building: No. of feet front ' No. of feet side No. of feet rear
23. 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 Signature Cal-,-ti Lt_ p'o ao— ev,,,,
PLANNING BOARD Address i be an/ hunt''- SO yart,o,-/ ,
Date
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