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1 / No. ..c* .l <a
�� • X ' Application for a Permit to Build
Fee must accompany this application 1 2�
Yarmouthpr" ✓ 19�a
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TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner SVr• Febvn6¢r Me,'1eLjrwl Address Se tibSterelY.,e ¶3Ass2w.rnays,
2. Name of Architect (if any) AL II" 4 `+uNw Mir Sri'. jolyPun is
3. Name of Builder (t) NAS.W U', e6. S o,'/stn Sk •
4. Precinct No. 41.,0
Lot No. nn Plan: Name or No.
741e
5. Name of Street b \ b {.ere U$vc ,Q ASS 12:.n r ,MA .
6. Purpose of Building Rem v u tIOw Or f.t.c IAF"a9C •$.hL ast-rarrteswS
7. Material W ♦o A Ft Aw.e
8. Estimated cost of building X41 000 et+
9. Dwelling NO
10. Cottage N ?$ es.0alefk
11. Heat /es - A-e'r W"z'r
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12. Basement — `v- ua�.. Stwe�
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13. Garage N b
14. Store 0°
15. Shop M D
16. No. of stories Z
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 front 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 distances from adjoining lots,� on reverse de.
Name..ItIDCt4? e ^M#e z 4 24'
Address 1 a eepLey 64t c
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117 • rI .Rear of Lot
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Frontage of Lot
Street Name
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PLOT PLAN
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