HomeMy WebLinkAboutBLD-90-580 -f•YA
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4 SIED` 6Ce Application for a Permit to Build No. a
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UPON FINAL APPROVAL OY/ MAP 27 LOT (c02.-
FEE MUST ACCOMPANY THIS APPLICATION. DATE Wago
The undersigned hereby applies for a permit to build 9/49 o
according to the following specifications
1. Name of property owner go SL joP,-Cw Tel.
Address /9 Zr)' PIE 5-7—.) Ki9-iv,e....04/ 4¼7
2.Name of Architect(if any) Tel. pp��
a Name of builder a i : • __./ 4 H •dress 1777 31x5* BeM/e49/4 T� •
4. License No. Tel. al 5-691-3029 ei 8'o 17
5. Name of Mason Address !r! g,si 4ir/5-eZ
6. License No. Tel.
7.Construction address 66g 81-2.1 wee Yarnzctcf/,
Flood District
a Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
Type of room No.
10. Multifamily 0 I I Ooo•eo GrAesmvcT
11. Commercial lid 1.C, ,cccSS Kitchen
12. Other 0 tni� Dining Rm.
13. No. of stories Living Rm.
Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0
45-SM
Gr° Bath
15. Materials — Wood 0 Cement VOther 0 Deck
16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
17. Garage — 1 0 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
20. Stove — Wood 0 Coal 0 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
PLANNING BOARD Addre � �a� t 2.(��� ,�� l �n J�
Date .el(