HomeMy WebLinkAboutApp# 18-E118 0
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TOWN OF YARMOUTH -
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F, $ 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 RECEIVED
Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
RECEIVED OCT 2 4 2018
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
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OCT 3 tU16 APPLICATION FOR OLD KING'S HIGHWAY
TOWN CLERK CERTIFICATE OF EXEMPTION
SOOTH OUTH, M
YARMA
Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs
accompanying this application.
Type or print legibly: QQ G
Address of proposed work: I Z3 V AtiA NLL1/\ `)Rs't t Map/Lot# I t ', -£0
Owner(s): C 'S 4 Me-LS54 cor-u-clea Girl-cPhone#: SSZS- -ciOSI{'
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: SA WCE Year built /q r�
Email:_C CtAki-bC(y A j}^sc,Tbj LDEC—S,CO Preferred notification method: Phone Email
Agent/Contractor: IA Pr Phone#:
Mailing Address:
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Email: Preferred notification method: Phone Email
Description of Proposed Work(Additional pages may be attached if necessary):
("?Att.f i' -Fite MT CLAP eC)(X2-r4 S A NO r-obit'PcOg-- Sfafry L S ie i1Y k 0
C1&Pcca.2`s - Gra.1 CtoOci S
fror+1- lY»r - Pecitertocr /
Signed(Owner or agent): / Date: 1°1 22( IS
D Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.)
D Thls certificate Is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
For Committee use only:-1 �/
/
Date: /�
14-1 6 Approved Approved with change p-p -- Denied—
Amount Reason for denial: �• ■ DOVE®
Cash/CK#CP,,t F\ OCT 2 5 2018
Rcvd by: 1241 YARMOUTri
OLD KING'S HIGHWAY
DateSigned10/Z�/2f1( Signed:J 6 APPLICATION#: )ce"LFIId
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APPROVED
OCT 25 2018
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