HomeMy WebLinkAbout20-E003 COE , 0
RECEIVED
,..?.(-i--':., 7:,,,,s0
y TOWN OF YARMOUTH
JAN 21 2020
x 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
' G Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836 YARMOUTH
OLD KING'S HIGHWAY
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
APPLICATION FOR
CERTIFICATE OF EXEMPTION
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: �� / �( j/
Address of proposed work: .G^� L/V5 P�z -/� ��/!�7- R*'/
Map/Lot#
Owner(s): 4 P!� / .2/ ,(95 \c.)
U�� ��7�c��� Phone#: y- �y
All applica ions must be submitt b o ner or accompanied by let r from owne proving submittal of application.
Mailing address: mar-built:built: /5 T
Email: Preferred notification method: Phone Email
Agent/Contractor: •iij J�2._ ."9-1/./9/I-- Phone#: 56 / 306c?2 3
Mailing Address: 86: n(2 2 h'Y7✓, A 1q,(%/(
� /7" //� 69,26'7 j
i
Email: 041-5 }/J ��� V G v (O /• Preferred notification method: V Phone er Email
Description of Proposed Work(Additional pages may be attached if necessary):
Aevr10 v dcc 1', w.'/Ick ws
-1441--..-- ' �
'�)20
Signed(Owner or agent): �� Date: Df! /.
> 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: /'�ll�0 V Approved Approved with changes Denied
Amount gQ0 Reason for denial: a .7, . " 1 RECEIVED
Cash/CK#: t 0 \
JAN 21 2020 JAN 11 2020
Rcvd by:
YARMOUTH TOWN CLERK
DLA KING'S I IIGt IWAY SOUTH YARMOUTH, MA
Date Signed: Zi 2G Signed: LJ� ' . APPLICATION#: 20-1-----60-3
V5.2017
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