HomeMy WebLinkAbout19-E0901,KINTOWN OF YARMOUTH
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1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 RF ,ibTelephone (508) 398-2231 Ext. 1292 -Fax (508) 398-0836SEP 2.� L'Q19
HIGHWAY HISTORIC DISTRICT COMMITTEE YkimlVIUUIH
OLD KING'S HIGHWAY
324 APPLICATION FOR
CERTIFICATE OF EXEMPTION
Application is hereby made for the issuance of a Certificate of Exemption-urndef Se,ct�ops ,nd 7 of Chapter 470 of
Acts of 1973, as amended, for the proposed work as described below and�'6 platin; dr6 aawings, or photographs
accompanying this application.
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Type or print legibly: SEP 4�
Address of proposed work: ��` lX cni iT o erg aCylERKtl' IA �l ail o
Owner(s): ev I n ! ��Gf Gt�/D r/�h Phone #: J? ,257 76— 3
All applications muslbe submitted by owner or ccompanied by letter from owner approving submittal
of application.
Mailing address: Uu� �dn� W Year built:
Email: L 4171 01-1 Preferred notification method: Phone
Agent/Contractor: /� / Phone #:
Mailing Address:
Email
Preferred notification method: Phone Email
Description of Proposed Work (Additional pages may be attached if necessary):
-/4- 3--1-�
r
Signed (Owner or agent): Date.
> 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 on
Date:
o a
Amount aS
Cas /CK
Rcvd by:
I/ Approved
Reason for denial:
Approved with changes Denied
:t'oviou I H
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Date Signed: ?/I- ZQ�! Signed: CJ(�. '4' /111
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APPLICATION #:
vs.2on