HomeMy WebLinkAboutBldg Exp 75 25 Hillcrest RoadTOWN OF YARMOUTH
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292 -Fax (508) 398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT CO
APPLICATION FOR
CERTIFICATE OF EXEMPTION
RECEIVED
MITtEL 3 2021
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:15 0 t -L ' _� > PC12�i Map/Lot # i l U�
Owners): t - UG �i Phone #:$519 36M.
All applications mugs be submitted by wner r accompanied by letter fromI
owner approving submittal of application.
Mailing addregs: �S �/�t�.lme �iR-�l � 02bll Year built: ll i 6
Email: e • L X51 L" CDMCATI Preferred notification method: Phone Email
Agent/Contractor: DLLJE,-� w Phone #-18 liUT(a
Mailing Address: \ AA o2b r
Email: Preferred notification method: Phone Email
Description of Proposed Work (Additional
pages may be sary):
atttached if neces�'T�
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Signed (Owner or agent)
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CD LO 2
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 only:
Date:
Amount
Cash/CK #:
Rcvd by:
Date Signed:
vs.zon
Approved
Reason for denial:
Signed:
Approved with changes Denied
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