HomeMy WebLinkAbout19-E013 6 Squirrel Run Approvedv
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56�.Y0 TOWN OF YARMOUTH (RECEIVED
e 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone (508) 398-2231 Ext. 1292--Fax (508) 398-0836
KING'S HIGHWAY HISTORIC DISTRICT COMMIT _ ING'SHI��
RECEiV@>'� df��l��'��11CHWAY
MAR -1 2019 APPLICATION FOR
CERTIFICATE OF EXEMPTION
TOWN CLERK
49&16Xi 1FNPAVfn6& 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 �y s�
Address of proposed work: U �(J Map/I_ot # V7
Owner(s): Lj'r_� _ c", Phone #: >/ a 70—?
All applications must be submitted by owner or acco partied b tt from owner approving submittal of application.
Mailing address: �' Ul �v� Year built:
Email:
Agent/Contractor:
Mailing Address: � Y 7
Preferred notification method: Phone Email
Email: CJ 1 40 1 L)q 1_,y ( LL Preferred notification method
1 (2 C)i24
Description of Proposed Work Additional pages may be attached if necessa
Phone #:
= W
Phone V Email
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Signed (Owner or agent): Date:
> Owner/contractorlagent 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
Cashln a
Rcvd by:i
Approved
Approved with changes Denied
Date Signed: -3+ Signed: 2 14, V i
APPLICATION #: ` Iq — E�DI a
V5.2017 SCANNED
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MAR -1 2019
YAKMUU7H
OLD KINGS HIGHWAY
AP�'R(�VED
MAR - 4.V:3
YAKIVIUUTH
OLD KINGS HIGHWAY