HomeMy WebLinkAboutImage_003.pdf - BLDX-23-15593 23309EXPRESS BUILDING PERMIT APPLICATTON
TOWN OF YARMOUTH
Yarmouth Building Department
I 146 Route 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
Jeitor^ 0*- lr)arrhau
Office Use Only
e",*i* Cfiffi4l')
Pcrmit cxptes I80 days from
issue date
16kbq7-O +Ju
CONSTRUCTION ADDR.ESS:
ASSESSOR'S N\TFOfuV,{TION:
i,
^i1Oa,,o*r rUJ,
t:DRECEiV
BUi
t;0v
L
Nlap Parcel
O\&NER:,1 / (p i nncyit 1 Ko
Joe King
PRESENT ADDRESS
W
N"TEL, #
N.d\IE tvLLILNc ADDRESS
73
TEL ;
tresidenrlat Est. Cosr of Constluction $
Home Improvement q Construction Sup
\I'ORK TO BE PERFO R\IED
Duration (Fire Retardant Certificate attached?)
Siding: # ofSquares _ Replacement lyindows: #
Roofing: # of Squares--( ) Remove eristing* (mar.2 layers)
_ Old Kings Highway/Historic Dist. ( ) Replacing tike for like Pool fencins
f.zzoo.@
ervisor Lic. # e!i L Oq?t (L
Wood Stove
Replacement doors: * I
Itrsulation
workman's Compensation Insuranc^e:,r(check one)I Iamtiehomeowner Vian, tl.re soie proprietor - I have Worker,s Compensation lnsurance
Tent
*The deb s will be dispos€d ofar:
I declarc under penalties ofperjury that the statements hercin containwill bcjufl cause for denial or ofmy Ic and for pros.
tA -{ rorrs <{o&on
Location ofFacility
ed arc true and conect to
cution under lvl.G.L. Ch.
Ay)icarl
1r/o*o",,
I s Signature
Signature lor ettrchmen
lhe best ofmy knowledge and belief. I understand that any false anslver(s)
268, Section I
Date: No, 1. 2o?,-7
Dare:It'7 -zoz=
Building Otficial (or designeeJ
ZoniDg District
Historical Disuict: i Yes _ No Flood Plain Zone: - Yes lNo
wrrhur 100 ft. oiwetlnndsI Yes : No
Approved By
Water Resource Protection Disfict'l Yes I No
CO\TL{CTOR:
Contractor Lic. #
Date:
Ei!L\]L ,A.DDRESS