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\y Application for a Permit to Build No.
• Fee must accompany this application
Yarmouth 19...
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications: v
1. Name of Owner Bcc- __.c.0 W C\3 p n I Address e .. uo� 1-4e•, W l0.f✓h
2. Name of Architect (if any) H/A
3. Name of Builder 1-1,Of T141/4(ANCAAI3X- SeQc\hLtcts
4. Precinct No.. Lot No. Plan: Name or No.
5. Name of Street Sc.,—C- /(o AleMp7 Cane.
6. Purpose of Building ea`c-,
7. Material 1..1000 c e_i AkjeSsal)L ys.6v.5 Caq— ,G1)0.( ` C39
8. Estimated cost of building /pp9 2
9. Dwelli
edit°Pet
10. Cottage MA, Lrx pS7/`✓F
Jy Alt G td
11. Heat j_l/RT J
12. Basement 1s/A.
13. Garage R`A
14. Store j./
15. Shop /dip,
16. No. of stories i
11. Is there to be a Store in the lower storey 110
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 distances from adjoining lots on reverse side.
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Street Name •
p Left Side Depth of Lot
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Right Side Depth of Lot •
Street Name