HomeMy WebLinkAbout19-E068TOWN OF YARMOUTH RIVED
x 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 2 9 2019
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Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-0836
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KING'S HIGHWAY HISTORIC DISTRICT COMMITTE�Ej I'VC-� HIGHWAY
JUL 3 0 2010 APPLICATION FOR
TOWN O ERK CERTIFICATE OF EXEMPTION
SOUTH YARMOUTH, MA
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: Ln
cAddress of proposed work: �(' ( ✓ / Map/Lot # /'?'5[0/
'Owner(s): e f� /(�� C�� til Y Phone #: �Z — S5 9
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address:
Year built:
EThail: C S -S� l 11�47 (JR 0 Preferred notification method:
Agent/Contractor:
Mailing Address: _
Email:
&I Phone Email
Phone #:
Preferred notification method: Phone Email
Description of Proposed Work (Additional pages may be attached if necessary):
Signed (Owner or agent): WDate:
➢ 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: —2 0� 9-12
Amount 0?
Cash/CK #:
Rcvd by: �Yl/
V Approved Approved with changes
Reason for denial: ! A iDr ®IOn L
JUL §
ied
Date Signed: 30 Signed: (9 APPLICATION #: ! 91-
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orraine Hanley <css 161147 @ gmail.com>
y 29, 2019 at 11:21:47 AM EDT
51147@gmail.com
RECEIVED
JUL 3 0 2019
TOWN CLERK
SOUTH YARMOUTH, MA
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APPROVED
JUL 3 0 2019
YARMOUTH
OLD KING'S HIGHWAY
RECEIVE®
JUL 2 9 2019
YARMOUTH
OLD KING'S HIGHWAY
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