38B-006 (56) City of Northampton
Massachusetts
` DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Buildingt1
Northampton, MA 01060
TENT PERMIT APPLICATION dp
(For Tents over 120 square feet)
Permit Fee: $25.00 Check k# 3
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: m1 }k G!k5 f"iiC�naLA kpo-enrywj��
Address: )2c� L)eJJ 41.,eo,1 Telephone: (q 13)
2. Owner of Property: s3(VNk Cv 1]oe_
Address: Telephone:
3. Status of Applicant:-Owner Contractor T
4. Tent Location Address): l�fa� SQ o� .i s c�e Q to �.
5. Use of Property: Residential: Commercial:
6. Description of Tent:
Size: NM der J 1 Vie,�s �;ine� �
Occupant Capacity:
Dates of Use: M•=y 11, 204
4
fo,.y I6� R }t� j►a +� ,
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: 6 Z- 1°1y APPLICANT'S SIGNATURE
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._
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