HomeMy WebLinkAbout20-E004O
TOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836
ING'S HIGHWAY HISTORIC DISTRICT COMMITT
APPLICATION FOR
CERTIFICATE OF EX EMPTION
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Apprication is'ii!?e(&&&l tor tne
Acts of 1973, as amended, for the
accompanying this application.
Type or print leoiblv:
Address of proposed work
issuance of a Certificate of Exemption under Sections 6 and 7 oI Chapter 470 ofproposed work as described below and on plans, drawings, or photographs
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Owner(s)0J"
All applications must be submitte by companied by letler from owner
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approving submittal of application.
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Email
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AqenUContractor
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emair: 5 Q.aLu"4($fut, tLt Gr.rt',\,,0il1,referred notification method: phone
ion of P Work onal a be atta necess
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For Committee use onlv:
Dale
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Rcvd by:
Approved with changes
Dale
Denied
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APPLICATION #: ffiC
u Owner/contractor/agent is aware that a permit may be required from the Building Oepartment. (Check other departments, also )z This certificate is good for one year from approval date or upon date of expiratio; of Buitding p;rmit, whicheve; daie shal be later
Date Signed
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HIGHWAYKINOL
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Mailing address.
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Preferred notificatio n melhod. ll phone Email
Signed (Owner or agent):
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Reason for denial:
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