HomeMy WebLinkAbout20-E008(,
TOWN OF YARMOUTH
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REcE'vdLD KrNG's HTGHWAy HrsroRrc DrsrRrcr coMMrrrLE / vL.:
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Telephone (508) 398-2231 Ext 1292-F ax (508) 398-0836
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FEB _ s 2020
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Applcatron is hereby m5?d for tn
Acts of 1973, as amended, for lh
accompanying this application.
APPLICATION FOR
CERTIFICATE OF EXEMPTI ON
e issuance of a Certifrcate of Exemption under Sectrons 6 and 7 of Chagler 470 ol
e proposed work as described below and on plans, drawings, or photographs
Type or print leqibly
Address of proposed work ')L3 {\T fl L:wtf
Owner(s)(As Of t- Tt^s o L LC-
Map/Lot #
Phone f:5og ?a-3 73/ I
All applicati
Marling address
Ema I
ons must be submitted by owner or accompanied b y letter from owner
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9 l. llZf Preferred notiftcatron method
/ LoL approving submittal of application
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Date
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Signed (Owner or agent)
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Amount ,O
Rcvd by 6^/
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_Approved with changes
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Reason for denial
FEB 0 5 2020
HI
that a permrl may be requrred from lhe Bu ldrng Department (Check other departments also )
This certrficale rs good for one year from approval date or upon dale of exprration of Buildrng Perm(, whichever date shatt be later
Owner/contractorl agenl gaware
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S igned
,ada-<.
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AoenUContractor.
Mailrng Addressl
Oescription of Proposed Work (Additional paoes mav be attached if necessarvl:
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For Commitlee use on ly:
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Den ed
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Date Signed:^f ^-f0,"APPLTCATTON *, )o- E2tY,
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