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$, r TOWN OF MOUTH o t, F,,
.."60 Application for a Permit to Build No. 63 a f
UPON FINAL APPROVAL �j lobo/90
MAP /3/ LOT 4 1
FEE MUST ACCOMPANY THIS APPLICATION. DATE fid - 2-Z19 90
The undersigned hereby applies for a permit to build (2.G�f �.iR-SS /77) ;---W90
according to the following specifications
1. Name of property owner 7VW/J OF y*eM10 UM( Tel. 77 S-Xi (0
Address 1if MIAMI 61001C, (2ohi W .Y mOUTM
2.Name of Architect(if any) Tel.
3. Name of builder — kaotiTH 3-R-CTPEe' Address 74 '-C•OWNSlobI. 2cAD
4. License No. Tel.
5. Name of Mason NONE Address
6. License No. Tel.
7. Construction address G£Aels eenecH CENTTE 5r. ftceiwtotln-t ha' NmtsS .
Flood District Do �0
8. Date of subdivision Approval • plain zone G Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
10. Multi family 0 2-000 • o-19 PC-MWOUD you Type of room No.
TEA
11. Commercial ❑ -Mee Ill Kitchen
StU,S Dining Rm.
12. Other ,t (MUAIIOI Oct.Go s coer STPD • ROOFING
13. No. of stories I keit2 �°R Living Rm.
K Bed Am.
14. Foundation — Full 0 Half 0 Crawl 0 Slab JS( 0,01../e,E.W Bath
15. Materials — Wood $T Cement g Other 0 Deck
16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 N, C. Closed porch
Family Rm.
17. Garage — 1 ❑ 2 ❑ 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 I 4 00 No. of feet rear cl 00 No. of feet deep 350
22. Size of building: No. of feet front I to No. of feet side ___I -• No. of feet rear I
23. Distance from nearest building: Front 350 Ft. side — Ft. side — Rear
24. Distance back from line or street (SO (113;;?rL&Lq From rear lot line ZO�O Side line 300
LOT RELEASED BY Signature 7 kreak . Re -
PLANNING BOARD Address 7 T ( ow- 6 & W-
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