HomeMy WebLinkAbout18-E127 .@.:,,:l
.°l =, x 1146 ROUTE 28 SOUTH YARMOUTH, MA 02664-4451
4 Telephone (508) 398-2231 Ext. 1292—Fax (508)398-0836
RECEt'! KING'S HIGHWAY HISTORIC DISTRICT COMMIT CE.Dec
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' APPLICATION FOR
YH+�tvljO I n AY CERTIFICATE OF EXEMPTION SOU to , S0�8
AllQ KNG'S H1GHW Ty ygR//��Cs4 .0
5cation is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of CFiRitkyr 70 of
Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photogrikhs
accompanying this application.
Type or print legibly: 1 V
Address of proposed work: �(l O Lc ...Q(j'\---vd,40.cYyt Qkj'i'kpo t-ell" Map/Lot#
Owner s): L4 ne.kite McCto Phone#: U•a5q- (.0(..-1All applicati ns must be submitted b+owner or accompanied by letter from owner approving submittal of application.
Mailing address: 4 6 L OOt.a U'E' 6 4 0 I A Year built:
Email: LownC IVA C Co'Mea.St, net Preferred notification method: Phone / Email
Agent/Contractor7BQ- .0 st f-1 soc.(0., r-jIyZG . phone#:s '3(p -pegs
Mailing Address Te0 6O? cab Cev m1l` MA Qa(a-5a
Email: IY1(O g. bakaerna-oe. Lam Preferred notification method: Phone / Email
Description of Proposed Work(Additional pages may be attached if necessary):
mo os e'Ks4S4i yle, 1'No0k ry\c..tr,o..l a iVi lace LO LA--k..
Yli� 40 ma.VC Imo, ►h &(o r- cL5 e_iceit,i G oto le .
oto vy , QO c- i% Y . e Q e,--.,'
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Signed (Owner or agent): Dater 1 ti Act/ 115 .L Y
> Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.)
> This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
For Committee use only:
Date: !�&��� Approved Approved with changes Denied
Amount (Rb Reason dial:
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Cas : rM 33 1��r-b0.1 7 a -r vei.J b.., �;c .�I C9-e�YJ.�I<)as-f- h
Rcvd by: &V
Date Signed: /,_�I Fr Signed: -1._>, `7"C ,d1 2_ C),y APPLICATION#: 8 _
V5.2017
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DEC -5 2018 DEC - ?C118 NOV n 2018
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TOWN CLL , KING'S HIGHWAY KING'S HIGHWAY
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