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'•� ?' ` "„ )) 1 �/�� Se�k�ri:i�nr"('�F;:fi kip,.,17+','" xrv'usr. i weltriati.t'�„A .,;:rlemi py 't��.,` <br /> II '",Lt co, er +rots gmiiihyv aA4t,r;> i' ti, 9 '�ievr.ar1 • '0 <br /> .. { �d rY' .t� Y { `4 f Y .aS .,F41 Cn' L { ,5 % <br /> ' ,. .;Buildi> g Fern t ,4 J 1 t.. A� ' u., , <br /> a �i.pp` ���t�o'n =� h tt ,�. �;,�-�r1` �rA��s �; <br /> Site Address. Lfly aim Sn Piwad-b_es cvA. 5&gl <br /> arcel No.: <br /> Lot: Block: Div: Addition: <br /> _ <br /> ' <br /> ' .�l N� - � � LE� ppR * hyLwiu .. � �'(]���ps TTQ� .4wi Ll d w«YlA.Name Name Name <br /> 'Tor' LlN.N <br /> SA.rA-L,F, k t,Pi.rJG _1-NC_ <br /> blwhng Address Marling Address Mailing Address <br /> Ii'l lLI ZSr' Sr . Q 0 1to/ 33L <br /> City: State: Zip' Clrv' State' Zip: City: State. Zip: y I <br /> �,��R-y eS l..rA .9ZL! -c336 <br /> Contractor Lic.No:. A k/A C.-ZL 1 t`{•ft <br /> Phone No.. a -0) 3 2/ Phone No.: Phone No.:Zg 32° 4 <br /> Contact Person: C. 11-tran (2,2_1.tvW C� Phone No.: 23 ?Da/ <br /> J <br /> yagrt� Off'�. <br /> t ''�PCLITIdAT'+i."6E icli., t}.lY, , e., ,, .• ,,, I:'Pr' .jt. , <br />(Chee/c One) <br /> Single Fatmly.>CMulti-Family: Apartment: Condominimum: Senior Housing: Retail: Office: Restaurant: <br /> Manufacturing: Storage: Bank: Assembly: Accessory: Automotive Repair: Other(Specify) <br /> DESCR1PrlON OF\,ORIC: 1<t%sr GJ L L_`C'bfl NLl l LA--01l2. -v ClI 30 La PELF <br /> fry 7 30 2_ c rf . 12ctJC.,EV"VI �uci_vv br'r ,, l \-\wsE -t-C.ARli-C-S <br /> 11�1,-'Imv 1. III,( 'Y,, .rlp" - r �7�;� q ).• .7.i- .. 'Syttlr.n t..1, +i <br /> '1 I � 1 I' I� � t.v (('�' i.r,�7}}���� mTr r �I rrr t I <br /> i �dl�'� IL , :1 .. . III w�J ,W.;d' ir`s P:', (�'pr TJ7�TIN ku In 'J t: ' r i <br /> . I a ....;..6n_ � )s4^Fv�F.kIT.� a'��n~1Za.�a:�....� a'satp, via..L' 1 r.�Y�.�' � ,i �R,L'ut.ts�a++.tJ fi u.,l <br /> Street Setback:_ ft. 1 2nd Floor: se (Circle Yor N) <br /> 1"Side Setback: ft. 3rd Floor: sf. Shoreline/Wetlands ' Y N <br /> 2"d Side Setback: ft. Basement: sf. Water on/Adj. To Property Y N <br /> Rear Setback: ft. ' . - Occ. Group: Soils Report Y N <br /> Use Zone: _ Carport Area: sf Sensitive Area Y N <br /> Type of Construction- Garage Area: sf Latecomers Agreement Y N <br /> Lot Area: SI: No. of Stories: Fire Hydrant(250 Feet) Y N <br /> Vu. of Dwellings: Building Height: Variance Y N <br /> Lot Coverage: Deck Area: sf Covenant Y N <br /> 1.'Floor sf. Flood Zone X A AE VE <br />?reject Valuation(Labor and Material Cost): ! 2 g g� Co <br />:HIS APPLICATION IS RECrl V ED BY THE BUILDING OFFICIAL UNDER THE PROVISIONS OF THE UNIFORM BUILDING CODE,AND SHALL EXPIRE BY LIMITATION <br />;ND BECOME NULL AND VOID IF PERMIT IS NOT OBTAINED WITHO 80 DAYS OF THIS APPLICATION. BY AFFIXING MY SIGNATURE I HEREBY CERTIFY THAT I <br /> LLM'I HE LEGAL OWNER OF I'IL PROPERTY FO WHICH ,HIS APPLI&1t4 IS ISSUED OR AN AUTHORIZED AGENT OF THE OWNER. ALL PROVISIONS OF LAWS <br /> W D ORDINANCES GOVERNING' IS TYPE 0 0 WILL BE COMPLIEr1 WITH WHETHER SPECIFIED HEREIN OR NOT,INCLUDING CAT S FOR INSPECTIONS. <br /> iTGNA'fUTtL: ` . DATE: t0 /S/o7 <br /> 1 <br />