HomeMy WebLinkAbout19-E057v
°Y TOWN OF YARMOUTH
x 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 RECEIVED
Telephone (508) 398-2231 Ext. 1292—Fax (508) 398-0836
JUN -- 5 2019
RECEQURI,-KING'S HIGHWAY HISTORIC DISTRICT COMMI EE , mrovivU I H
QED KING'S HIGHWAY
')UN 07 2019 APPLICATION FOR
CERTIFICATE OF EXEMPTION
TOWN CLERK
SOUTH yAR
Application is f�ereWMIde�*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:
Map/Lot # I `�.
Owner(s): -r Phone #: i�'1`43� _ `lsS_
All applications ust be submitted by ovWer or accompanied by letter from owner approving submittal) of application.
Mailing address: (/� Year built: / / (ted
Email: l�t'CJrr`iPo �f/_� Preferred notification method: P"Phone Email
Agent/Contractor:
Mailing Address:
Email
Preferred notification method:
Description of Proposed Work (Additional pages may be attached if necessary):
Signed (Owner or agent):
Phone #:
Phone Email
jo _T SIS
Date: 15
> 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: �U J`� —�
Amount
Cash CK 3
Rcvd by: LX3\1/
/Approved
Approved with changes
Denied
Date Signed: 6L7_-OlfSigned:
APPLICATION J 9
V5.2D17