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RECiiVEDd'EXPRESS BUILDING PERMIT APPLICATI
]'OWN OF YARMOUT}I
Yarmouth Building Depnrtment
I 146 Route 28
South Yarr.routh, MA 02664
(508) 398-2231 Exr. l26t
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BI,JILDiNG DE PARTMENT
By
Nov 06 2923
-a+CONSTRUCTION ADDRESS:
ASSISSOR'S INFORMATION:
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Map:ParceltOWNER: 5A MEs ED t{-) A Ros I? OIJUEP'.(;774-4c2 9S7LNPRESENT ADD s TEI,, #
CONTRACTOR:3 (,
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-llResidential ECommercial Est. Cost ofConstruction $12
Home lmprovanent Contractor Lic. #s Construction Sup.rviso. Lic. #
Workman's CompeDsation Insurarce: (chcck o e)0 I am the homeownc. O I am $e solc proprictor fl I hare Worker's Compensaiion Insurance
htsurance Companr' Name c\c?.Worter's Comp. Polic)+
WORK TO BE PERPO RMET)
Tent Duration (Fire Retardart Certincate sttached?)
Replacentellt windows: #Siding: # ofSquares _
Roofilg: # of Sq uarcs (ffi) Renove existing* (mrx. 2 layers)
Old Kings Highway/Historic Disr. C] Replacing tike for like
'Thc dcbris *ill bc disposcd ofar
Loartion or [i
I dcclare under penalties of r) lhat thc nwillbcjusl causc lor on ofmy licansa
Appltsant s Signaturc:
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Wood Stove
Replscement doors; #
Insulation
Pool fencins l-t
and corRct Io lhc b.st offt\knowlcdge and bclicf. I undcrstand thsl ary falsc answc(s)G I- Ch. 258, Scctron I
Datcl
*()wncrr Sig!!turc (or rrr.hmcDt)
Appr0red Bv:
Drta:
Datc:
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cial (or designce)IIM II- At)D,I,ESS
ZoninS Distt ict
Hisrorical l)isrricr yes N()
Water Resource protcction Districty.s No
Flood Plain Zonc: ycs
Within :00 fi. of Wetlandsiycs No
Boilding Offi
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