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��� Li� No.47-415—(P
Application for a Permit Build
Fee must accompany this a lication
Yarmouth fig' 195..
TO THE BOARD OF SELECTMEN•
The undersigned hereby applies for a permit to build, according to the following specifications:
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1. Name of Owner RT Z8 VEAt_a TrivST Address to N. rytgtp ST. iSol4 AC.
2. Name of Architect (if any) -
3. Name of BuilderV4V•rl pso,,t GS Co . -
4. Precinct No. Lot No. Plan: Name or No.
5. Name of Street R4 zg /O%a - /091j GCte 11
6. Purpose of Building &t ce2ATCDta 'Co Ism' St me-1 of .tC6 ---e;0W.1/4trx- 4145. Acta
7. Material ,Ai Zoe._ -$enc. tL
8. Estimated cost of building 12.601st"
9. Dwelling
10. cottage / Jf ic2 A IteKilcu3 CN7
11. Heat
12. Basement ND
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13. Garage /.+O
14. Store
15. Shop
16. No. of stories Opc
17. Is there to be a Store in the lower storey
18. Size of Lot. No. of feet front No. of feet rear No. of feet deep
19. Size of building. No. of feet front No. of feet side .. No. of feet rear
20. Distance from nearest building: Front ft.; side ft.; side ft.; ar
21. Distance back from line or street , from rear lot line , side line
Show by diagram the location of propsed building with relation to d' / from lo' ng lots, on reverse side.
Name... !'
Ad ss Cie
ilk' 41/1/V (5'74 SC,r f
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Street Name
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O' Left Side Depth of Lot -
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Right Side Depth of Lot
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.Street Name
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