31B-253 (17) City of Northampton
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IA (l {�� : DEPARTMENT OF BUILDING INSPECTIONS
d r'�' 212 Main Street a Municipal Building ie ,D
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TENT PERMIT APPLICATION y
(For Tents over 120 square feet) 221 1.
1.2
i
Permit Fee: $30.00 Check # 48 70 Li (P a
PLEASE TYPE OR PRINT ALL INFORMATION
1 Name of Applicant Sr,I ILCoHeir., �`,I,J.1 Koren'a w_ik+
Address. IIL (aej Spe. t Telephone (413) 685 - 245 ,9
2 Owner of Property:
Address. Telephone:
3. Status of Applicant: Owner Contractor
4 Tent Location Address). A I LAM( 0 e 4;eJ„. tr. A IGVA
13 'Elm Stix 4
Parcel ID: Zoning Map# - Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Properly: Residential. Commercial.
6. Description of Tent. "
Size: I - 20'x30 04 I -20 �A2-0 (no} C'anne( d l) k
Occupant Capacity: Ht I 5
Dates of Use. o� 1.9 2o1- IC In(', I Zci7
r lzr_;� 37-,r,‘ 0, pi., 1'9`-,26.13 cik 1).c.: 4.:.1 i
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: 3' IC-20I 4-' APPLICANT'S SIGNATURE Q/L--"
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.