31B-203 (7) City of Northampton
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t �- DEPARTMENT OF SUSLDZNG INSPECTIONS p
� 212 Won Strout * Municipal Building JJ,ai
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Northampton, MA 01060 S A:05\\
TENT PERMIT APPLICATION
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(For Tents over 120 square feet) �0 ��
Permit Fee: $30.00 Check# g6 /r€0 ;.
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 5(r11 IL a Tier, (3,`,L AA
Address: 12G Wu� siiree � Telephone: (H3) 5D.i-2u50
2 Owner of Property.
Address: Telephone.
3 Status of Applicant- Owner
Contracto
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4. Tent Location Address) l.J 111 Sc t'W 0 1
33 "i r_ ec� S?iee�
Parcel ID: Zoning Map# - Parcel# Disirict(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5 Use of Property. Residential Gomme-mat:_,
6. Description of Tenni. I
Size: 0t - 9 1- 10 ....le^�J C,nAcJ .t
Occupant Capacity:
Dates of Use
Z ALL INFORMATION MUST SE 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,���� II
DATE:)`,1'�P/ x-24-Z°l APPLICANTS SIGNATURE G
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.