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• Application for a Permit to Build
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'Fee must accompany this application
Yarmouth C+a l 19.P
6 - 0-0
TO THE BOARD OF SELECTMEN •
The undersigned hereby applies for a permit to build,according to the following specifications:
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1. Name of Owner ff0L`¢ 177 0. Verrl '¢r Address ) 7g foivag-c" ed ca.ticitent
2. Name of Architect (if any)
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3. Name of Builder S` 4-Mf
4. Precinct No. 3 Lot No. Fi d-1,%f
Plan: Name or No. A ., • 1-/9
6 Name of Street S /t/YJ,[z r J7o /-0124
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Purpose of Building U T.fA • '� v
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6: �� � /"� (3 � � �( J
7 Material M CT fl- V
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8. Estimated cost of building O-u, •
9. Dwelling
10. Cottage 5.-0
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11. Heat
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12. Basement .
13. Garage
14. Store
15. Shop
16. No. of stories
17. Is there to be a Store In the lower storey
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18. Size of Lot. No. of feet front fa Fr No. of feet rear t..t! t... No� of feet deep ,t o
19. Size of building. No. of feet front ALT No. of feet side tat r No. of feet rear L....aC
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20. Distance from nearest building: Front 0V ft.; side JC..a ft,; side £0 I ft.; rear..!a..r0
21. Distance back from line or street VD from rear lot line 21 , side line
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Show by diagram the location of propsed building with relation to dist from adjoining lot n reverse,side.
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Address 17 Y••:•� tl^� G��``'• �4
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• Rear of Lot l/
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Frontage of Lot: /at,
Street Name J ' r-4 ed ..
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PLOT PLAN . . .