38B-006 (62) City of Northampton
Massachusetts _°' `
DEPAR NT OF BUILDING INSPECTIONS 7t1'
`( 2h2' n Street • Municipal Building �fsi1.
) 20I4 ✓I Northampton, MA 01060 �'1} fir,.
LJ
Electric. Plumbing&Gas Inspections
Northampicn,fJIA 01060
ENT PERMIT APPLICATION
(For Tents over 120 square feet)
Permit Fee: $25.00 Check#
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: S n i A G flg�e fiiGL { l'(ol?2n icy W 1 G�
Address: )2C lje j ` ,lrQ� Telephone: C`115 ` ,q5 "?—q�—y
2. Owner of Property: c3 on I t co 11t>90
Address: Telephone:
3. Status of Applicant: Owner Contractor
4. Tent Location Address):_ TV, t[0.,) p t l M�ah F�o,�1
106 L G-16jc L,F,.C.
5. Use of Property: Residential: Commercial:
6. Description of Tent:
Size: I ` 20 ri 20 ' ieJ
Occupant Capacity:
c
Dates of Use.! 2g-201q -4
Tl�ciJ �-2b lal� wl�c• IZ.JJ
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: "Z) '2u ty 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, Depa t of Public Wo s and other
applicable permit granting authorities._