35-110 (2) l
Date Filed File No. _
ZONING PERMIT APPLICATION (§10 . 2)
1 . Name of Applicant: E_`�, ipsyt+,
Address : aa CQv\L_��\s *-VaQ,RAca Telephone :
2 , Owner of Property:
Address : —Telephone:
3 . Status of Applicant: X owner Contract Purchaser
Lessee other. (explain:
4 , Parcel :identification: Zoning Map Shee ,�. - Parce_-,/�,
Zoning District(s) (include overlays)
Street Address °
RecTuired
5 . Existing Proposed _ by _,.�,gt)incr
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%Bldg. Coverage (Footprint) _
SetY)acks - front IVA* �^
- side ICs'
- rear '
Lot size
Frontage - --
Floc;r, Area Ratio
%Open Space (Lot area minus —
tuilding and parking)
Parking Spaces _ � -----
Loading ---- ._.
Signs -- ---------
Fil.l (volume & location)
6 , Narr at-ive Description of Proposed Work/Project : (Use additi0 iia.1 .meets
if necessary) C JS VC3� crr I� .w S�AN�AW►J. _— A
7 . Attached Plans: Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained r.erein
is true and accurate to the best of my knowledge.
.Date: `�'— a- "` l Applicant ' s Signature : e
- _ - - - - - - - THIS SECTION FOR OF'F'ICIAL USE ONLY: - - - - -
pprove,cl as presented/based on information presented
Denied as presented
rl f•or Dori i
as /� -c
`lxa p
ignatur6 of- Builds nspector Date
NOTE: issuance of a zoning pormit dons not roliuvo an applicant's burdon to comply wil}i all zoning roqufroments and obtain a;l,_quire_ p;:nrfts
from the Board.of Flonith,Consorvation Commission, Dopwtmont of Public Works and othor applicable pormit grwiting autharftios,
'•d , zlP 't,
.. . •p1� j��� � yllussn�llu�iilo �F— J
,AN 3 l�r;r�nrt'r'r,(cr•r'r c)r'
' 1G �)lr)i li:flllil t3ll'PUl ' '(,I'1111i!'117111 ):(1111C1(11(i ^�'ti'-.-
, INSPGG'I'C>R
ilol'll�nlni'>I:on, 01000
AS A HOMEOWNER I UNDERSTAND THAT I MAY APPLY FOR AND R C
E I V R
A OUI�pING PCRMI 'f FOR A 119ME OR ADDITI011 ! IN'fl�.h10 'I'0 I. IVC ' N ,
I Al.SO UNOCRS'fANO 'I'11/�'I' I AI'1 R(:SPONSI(3LE FOR KNOWING 'I'H •STATIS
I3U I l 01 NG 000f AND ZONING PRO I NAf'1C(: OF 'I'I It: C I 'I"( OF f�•OR'I'I'IAr�1f'ION ,
OF:ING A,i'10(rfffOWNSR AND NOT A PROF CSSI01'IAI. CONTRACTOR IN NO WAY
ABSOLVRS ME OF ANY RRSf OflS I f3 I L I 'f Y '1'0 ( IlSUItI: THAT AU. FACETS
COMPI. ( li('
OF THE RULES AND REGULATIONS ARE 1 WITH ,
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