38B-006 (61) City of Northampton
Massachusetts
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DEP T OF BUILDING INSPECTIONS : ?`
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i AW 2 ' 2014 +16rthampton, MA 01060
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TENT PERMIT APPLICATION
(For Tents over 120 square feet)
Permit Fee: $25.00 Check#
PLEASE TYPE OR PRINT ALL INFORMATION f
1. Name of Applicant: �mI'A (i)1�}e ��t��R S'(cf ehr� I� 1G.il
Address: �.�"f i 1cjj 4,1/-ee."� Telephone: (q I"3) fy
2. Owner of Property:.. (h.- C. it e�g
Address: Telephone:
3. Status of Applicant: Owner _Contractor
4. Tent Location Address): Sr'Oye— `awe 6y NSIPJ-A 14.��
_$Z0111,n(�M
Parpc III
5. Use of Property: Residential: Commercial:
6. Description of Tent:
Size: 1'2D1xL� IC� �
Occupant Capacity:
Dates of Use: lGyuv?. Zo► ��i�( SeP +L�2% S 1014
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: V'2) - ZU 1!j APPLICANT'S SIGNATURE �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 Conserv, ti Commissi n, Department of Public Works and other
applicable permit granting auth 'ties._
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