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çì ... No.; Application for a Permit t' uild
Fee must accompany this ap 'cation
Yarmouth y- 3 19
5 tut
TO THE BOARD OF SELECTMEN
The undersigned herebyapplies for a permit to build ccording to the following specifications: '
1. Name of Owner`�i�/w2�2 Address
2. Name of Architect (if any) FaLre •
3. Name of Builder
4. Precinct No. 72 o.Lot NV Plan: Name or No. _
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5. Name of Street t---W-0-0--rt
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6. Purpose of Building `"
7. Material
8. Estimated cost of building _3 2 t y
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9. Dwelling
10. Cottage /6
ottage -V-e)
11. Heat
12. Basement ..,�
13. Garage
14. Store
15. Shop
16. No. of stories
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.; rear
21. Distance back from line or street from rear lot line ' , side line
Show by diagram the location of propsed building with relation to distance corn joinin lots, on •v• - side/
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Address 72. .. ... .. / �h
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Frontage of Lot ,
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Street Name
PLOT PLAN
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