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#67 1
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41 1 8° Application for a Permit to Build
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J Fee must accompany is application
Yarmouth 7ll 6?Aa. Pts7 S'o
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TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to b d, according to the following specifications:
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1. Name of Owner ETA Ai es L /I 6t) 5 ON Address POPPOA) E 5 $ C 7-- 1 s 1- 4 4-7-1)
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2. Name of Architect (if a )
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3. Name of Builder
4. Precinct No. sj Lo J. efi evestfraragel or No.
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5: Name of Street
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6: Purpose of Building
7. Material ii,S, _iyq a44,A.eacc..__
8. Estimated cost of,buildipg..0.4.) , .....ateco
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9. Dwelling /X
10. Cottage Add rt.I-1 .iciiixEc r ‘ a itrit.
11. Heat A/C.1
12. Basement/%) d 36 9 chi ea;, ._.0tts
.13. Garage fidC(&)1-0-1stitgk
14. Store /hA
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15. Shop itO •
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16. No. of stories
17. Is there to be a Store in the lower storey AO . . ..
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.; r
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 r erse side:
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Address.a.c2M7rfi4flha2ae LI24612-14
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Street Name
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O Leh Side Depth of Lot
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Right Side Depth of Lot
Street Name
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