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V,'LattApplication for a Permit to Build No. —
UPON FINAL APPROVAL % /FY iOMAP J-7 L. ' —
FEE MUST ACCOMPANY THIS APPLICATION. DATE ' 19t
The undersigned hereby applies for a permit to build // 7//990
acco�r ng10 the following specifications
came ame of property owner J oh V\ A-r bo 9qn 'St- Tel. 3gy— 769/
Address 5 Na 'n A ' 5 fl7cc/ toy° rvnncJ (±j
2.Name of Architect(if any) Tel.
3. Name of builder _ Address
4. License No. Tel.
5. Name of Mason _ Address
6. License No. Tel.
—7.'61struction address N a RC1` S GO c� (20 YO `r VI/No u i-A')
Flodd District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling ❑ Estimated Cost DO NOT WRITE IN THIS SPACE
Type of room No.
10. Multi family 0 , 1 \ CUU°o -- ---
11.
11. Commercial 0 Kitchen
12. Other ❑ Dining Rm.
13. No. of stories _ e Living Rm.
Bed Rm.
14. Foundation — Full ❑ Half ❑ Crawl ❑ Slab ❑ Bath
15. Materials — Wood 0 Cement 0 Other 0 Deck
16. Type of heat — Oil 0 Gas ❑ Electric 0 Other 0 Closed porch
Family Rm.
17. Garage — 1 0 2 ❑ Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
20. Stove — Wood 0 Coal 1-1,1 i iel---/ 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. )r`O_A-c l Cul)U Ort-74—
PLANNING BOARD Address l�
Date