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App# 18-E134
TOWN OF YARMOUTH x" .lay I„fix 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 RECE Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836 ��II • ED „LC9 Z01 LD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE DEC 8 2018 11rowN CLERK APPLICATION FOR • v,� rniw�lu l n SOUTH YARMOUTH, MA CERTIFICATE OF EXEMPTION I OLD KING'S HIGHWAY Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended; for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: Address of proposed work: I” y /1?1,D7 yhZnw,,r n,q,,v,gfap/Lot# Owner(s): RtCi ✓✓} te f�q y2 i rye=TT� Phone#:OOR - 73 7-c-1 d 7 All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: >7 y7 Year built: Email: R. l T Alr L. r(9 /L1,S kiii-i-ke RIfreferred notification method: Phone Email C0 >vz Agent/Contractor: DA-5/ � i /�/3.�j Phone#: )O d-- s66 332 Mailing Address: 12 3 c c '-(I f h s , L. -2,:q- Ua- 6 Email: A�- (�/1�/���, c O Preferred notification method: I Phone Email Description of Proposed Work(Additional pages may be attached if necessary): Signed(Owner or agent): - / ����,✓� � . ,> Date: /2 —7 Jr 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: lo?.--/8-JI a' Approved Approved with changes Denied Amount (90 Reason for denial tI APPROVED Cash/CK#: 25626. U EL 1 to 018 Rcvd by: �-17-/ YARMOUTH OLD KING'S HIGHWAY. 2./1 g/Z ( �Date Signed: ! 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