38B-006 (58) City of Northampton
r Massachusetts
1 DEPARTMENT OF BUILDING INSPECTIONS r- x cIrt
1} 212 Main Street a Municipal Building
Northampton, NA 01o6o
In
PPcti°�5 TENT PERMIT APPLICATION
P�n roa ,4�r,050 ,
E1ecU,c C
(For Tents over 120 square feet)
Permit Fee: $25.00 Check #
yy PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:_ Is n r Yk C, V— k f?eh ro tj j k, _
Address: ):2(, l.Je.Jj jll leo,-i- Telephone: (q l�) 's3s -zgfy
2. Owner of Property: 3(h i k C. l eater
Address: Telephone:
3. Status of Applicant; Owner Contractor
4. Tent Location Address):_
�TOEBE F1t�LED 1N BY,THE BUIL-DING,�2�,�EPAR7MENT1'
5. Use of Property: Residential: Commercial:
6. Description of Tent:
Size: �-
Occupant Capacity:
Dates of Use: VI v\ '�c, Zi} l `1 7 �)�t�� ��3• ��°iii
It, Zvi�I (fAOc• �
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: Ct - I ZC i �� APPLICANT'S SIGNATURE_
NOTE: Issuance of a pen-nit 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._