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Vc ' Application for a Permit to Build No.
Fee must accompany t s application c�� �,//
Yarmouth 2)t1..&r. 19.20
9-0
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner rrR'1`'ea )1• ..”4-11-14742j• i Address 5t96 V-A441.1-ma i
2. Name of Architect (if any)
J. Name of Builder -rOt vwc
- 4. Precinct No. Lot Net, /, nn Plan: Name or No. r1 hj 5I
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5. Name of Street .04gjys.Q�tJ ,
. V
6. Purpose of Building 1-4Q-o' -se' S,.cot a
7. Materialg..4-A-441:4-44-4 e 12kt
8. Estimated cost of building f g 4+S °/
9. Dwelling
4 0✓!�^.
10. Cottage
s 11. Heat
404, 1.4 lifin.
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
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19. Size of building. No.!of feet front 5 — No. of feet side V No. of feet rear
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20. Distance from nearest b7uiilding:`Frro ft►' " C ~''ft., 'side dl`s 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 adjoinin\ lots, on reverse side.
Name. �,- -t..NJ\ �C�
Address Ll Le Vi.\... .. . 45-y, •('-�3... c�
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Street Name
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Left Side Depth of Lot • Y rt
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• Right Side Del of Lot C • 0 �r
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// r �et Name/ / i .. . i
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