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"'..'. The Commonwealth of NSa"adh4SELIS - Building <br /> ' • <br /> ° ulatlons and Sundards Building Department No <br /> Slate Board of tlu"Its c l6 Great 1 Road North <br /> Iriasdachuuus. .c Bullding Code <br /> 150 CMA <br /> APPLICATION TO CONSTRUCT.REPAIR,RENOVATE OR DEMOLISH A ONE OR TRO FAMtI.V D'wE LLING <br /> T7Ja Session For Official Uae 061Y <br /> Building Pc.mil Numb , Dam Issued: <br /> -J <br /> Signature' D.... __ <br /> ay.u„ fuuuuio.�llNs la d awtdln s <br /> SECTION 1.-SITE INFORMATION <br /> 1.2 Asscssws Mup 6 Parcel Number <br /> 1.1 Propeny Address: <br /> 1 ► T'k aL- - <br /> VA.e . t per— A.I.p H•mG.� Pr rel M.men <br /> zolung. in F r+� L.11 Coveragr%: �l <br /> L Tonin;Inforrnaion: - c� r� � � IA Property Oim<nsions', — <br /> ¢31 1 D P(t"S�S2LT-M L - 'S6O '�.F <br /> I IaA UUn Fnw Pq <br /> aMa P:�ui Plaposea Ur —1 �---�� <br /> 1 6 Bulldmg SctErks fD) �__ -- <br /> Side Yalds kear Yad <br /> Franc YarJ F- <br /> ---1 <br /> c P.o.idcd Requlicd <br /> Pmvideo PranJtJ <br /> rZpr to / fo - / 19.29. 1f%xo—q b I.g5cralcDispSYnem: <br /> 1.7 Wamr upply(M G L.C.eo. `5a; LS Forel IDrw Map __ <br /> 1.7 W le Pn.uc❑ Zone <br /> Outside Flood Zone❑ Munt.F+I O On sre llspo"t STucm pg <br /> SECTION I.-PROPERTY OMNERSHIP!AUTHOR IZED AG ENI' <br /> 2 1 Q.Mr of RctoN. <br /> AJJ.w M1n S.rvo-r <br /> N A 1Pnat <br /> anY•1. <br /> 2.2 Authorvacd Agent: <br /> -- a6v<u f✓ <br /> MpnY Ilriml <br /> L•apnw _ <br /> SLCTION3.-CONSTRUCTION SERVICES <br /> _. NM Appiicablc l3 <br /> 3.1 I.KCMW Conatn.IIion Supel""'t -- <br /> I <br /> L<.n..0 Canurur.cn Evp...e _ <br /> ._ 4pam Ou. <br /> AJd.0 <br /> Siati.u.. T.uprm� -_ <br /> Nui Appliublt U <br /> 3.2 Ryu!crtd Home Imprwemcm Conuaaar: <br /> L'ums imla <br /> Ccnp.nr W: <br /> ErDu++lon Cu. <br /> amnu <br /> Teuswnne <br /> Sgnuw. <br />