38B-006 (42) City of Northampton 3C3-‘
,e '< Massachusetts ~ ,�
DEPARTMENT OF BUILDING INSPECTIONS
t 212 Main Street • Municipal Building
Northampton, MA 01060
47 /1
�j TENT PERMIT APPLICATION
�c ��3 ` (For Tents over 120 square feet)
o IS) ��� , dos
Permit Fee: $25.00 Check#
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: S M 11-k Co Ii j �rck° '� ko ri-en-io
Address: 12G, Lie-14 sSJ-r'ee,4 Telephone: Cq t1) 673s -2c/c9
2. Owner of Property: c3 p), C„ 11 eg -
Address: Telephone:
3. Status of Applicant: Owner Contractor !�
4. Tent Location Address): 1 t� ��1�^ 11, e ( f Ce.1,a('A 1 3 11•11
?c4f ad,lat I`�iac�
r ar f r7 s..Y 6 s,# -p' r, ,+� .v a T"'* t.-Kt .'° 't "f' 3 nX
d(CP D:g"1rt� 4RMaI . 1;Kerctd ?�aSaigiq kt .�� a�.kv. �. .. ; . . -f,tS
5. Use of Property: Residential: Commercial:
6. Description of Tent:
Size: (I1 3 "x104) 1- j2'-2o '/.2OctnJ1 1- 1,00' C34Aec�
Occupant Capacity:
2cc M.r4nrg 4
Dates of Use: 4 FfscLy Seplers6e .Z O, L013 73?M T. i .
Se f' 1,6a,_ I(1,24 i 1
A 00.3 3 0,0 4)
7. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
8. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: q- 10 "2 0 13 APPLICANT'S SIGNATURE Gt.js. I.
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements
and obtain all required permits from the Conservation Commission,Department of Public Works and other
applicable permit granting authorities._