HomeMy WebLinkAboutApp#19-E056N
°�Y TOWN OF YARMOUTH
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x 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 RECEIVE[
Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-0836 �Y'J
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RECEIVES KING'S HIGHWAY HISTORIC DISTRICT COMMCOMMITT E yHKNI(Jt)IH
OLD KING'S HIGHWAY
jUN 07 2019APPLICATION FOR --- ----
CERTIFICATE OF EXEMPTION
TOWN CLERK
Apgl�%t R,Mffe I�a�for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
Acts of 1973, as amende for the proposed work as described below and on plans, drawings, or photographs
accompanying this application.
Type or print legibly:
Address of proposed work:
V �QwG
Map/Lot #
Owners): C_ -44S � p,�SSA Phone #: Z;b � - S(A--10 J
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: Year built:
Email: CIC 4kLAQ5 e [.0M. Preferred notification method: Phone /Email
Agent/Contractor: (�%���i �"ii" � 5 Phone #: '�;U y - 1j(44- 1 o s
Mailing Address: 4;31 iqlUTZ 29 1 r�'f''-j
Email: c=—'-,,A4AE AS Preferred notification method: Phone �� Email
Description of Proposed Work (Additional pages may be attached if necessary):
Signed (Owner or agent): Date: OV S/(
➢ 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: ^SLT
Amount QL0
Cash K #: LNS-O—
Rcvd by:
Approved Approved with changes
Denied
Date Signed: 6 7 �Zo' 9 Signed: - � e
APPLICATION #:
V5.2017
E0�,b
RECEIVED
`SUN 072019
SOUT OWN CLERK
H YARMOUTH, MA
RECEIVED
JUN -5 2013
YARMOUTH
OLD KING'S HIGHWAY
19 E056