HomeMy WebLinkAbout19-E035TOWN OF YARMOUTH _
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 'RECEIII�
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Telephone (508) 398-2231 Ext. 1292–Fax (508) 398-0836 Ii N
KING'S HIGHWAY HISTORIC DISTRICT COMMI TEEAPR _ 4 209
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APPLICATION FOR 0_ KING'S HIGHWAY
CERTIFICATE OF EXEMPTION
for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
for the proposed work as described below and on plans, drawings, or photographs
accompanying this application.
Type or print legibly: 4(C?
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Address of proposed work: 6 7 / " �' �Ny�� >'�
`7 0 Map/Lot #
Owner(s): �` Q� c3 4�> `14je—C L Phone #:
All applications must be submitted by owner or accompanied by ktter from owner approving submittal of application.
Mailing address: Year built:
/,- 6
Email: e A-) .Ny 6 V f I L M 17 5re� d notification method: Phone Email
Agent/Contractor: Phone #:
Mailing Address:
Email: Preferred notification method: Phone Email
Description of Proposed Work (Additional Daaes may be attached if necessary):
F4_ -PA %'V -t ('d l2,Te-9 GApt4 4,P— CL�IKov2H RvcK
Signed (Owner or agent):
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Date: 91�- Z/ ` 2 c' 2
> 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: Ll—Ll —i %
Amount 20
Cash/CK #: CA5j-f
Rcvd by: 6V
/Approved
Reason for denial:
Date Signed: V� ( Signed:
V5.2017
Approved with changes
Denied
KINGS -'HIGHWAY
APPLICATION #:.