31A-065 (2) City of Northampton
r Massachusetts
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tom38td DEPARTMENT OF BUILDING INSPECTIONS ,y
Jy� P1' Main Street S Munampal Heading m0�
\e-...4' Northampton, MA 01060
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! TENT PERMIT APPLICATION
(For Tents over 120 square feet)
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"""0'0E° Permit Fee: $25.00 Check# �
!! PIEASE'TYPE OR PRINT Al.I..INFORMATION
.1 'I. Name of Applicant SMI 4++ l
n W?/ck p. Fe.iov- 1 kor?en lqu`Po, ..
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• t Address: 12.4 LieJ4 anal Telephone: (4/1) S33--Zgty
2. Owner of Property_ JfnllL C„ /(gpe. ..
Address: Telephone'.
3. Status of Applicant: Owner _,. Contractor
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a_ Tent Location Address): I '44fctrA�.(? I ICea,It TA o,cAe CAA,a
-TA t 1 14(44444 t Comm €.4(erv,e,~ f'.... 20)i
Parcel°1f}„ nlritM .Trtt' racer FMc mar tract(s)q v+t`.`^,'—'-`ac. 'n5� �t`h:.,'ry s;:
,,,,,41.L. . -, .�a<.ILAINN:D? PP233'3i€N'R
5. Use of Property: Residential Commercial:
6. Description of Tentt,: }}'� (t 1 r�
Size'. N!±hb3 tre G l2u T S G> -o .d
Occupant Capacity'.
Dates of Use PACT"! hj" j : May 2c0 20t
'?te.,e S..,Ps..l Fr,b.y nny 434 2 '11 ,;j S,w 12 s2 n. .
7, A�NF'ORMATION MDST BE CQMPLETED: PERMIT CAN s s ENIED D._ • LACK !':INFORMATION,
S. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge. ,,//��JJ
❑ATE( �-+ I -2e It APPLICANTS SIGNATURE �C�6""'
NOTE Issuance of a permit does not relieve an applicants 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._