31B-081 (14) Date Filed � f� 2i 00012 r' File No.
ZONING PERMIT APPLICAAT+ION (510 .2)
1 , Name of Applicant: F _eA Cu S,O-n moi" n S
Address: 62-`1 ( n- e Telephone: 5 Q[- ABY ('2
A
2 . Owner of Property: e. n -erSOh
Address: 13 Telephone:
3 , Status of Applicant: Owner V, Contract Purchaser S16-N m A KER—
_Lessee _Other (explain: pp )
4 . Parcel Identification: Zoning Map She�q 3 /J Parcel# Q� ,
Zoning District(s) (include overlays) N
Street Address 13 1 ICIN
Required
5 . Existing Proposed by tonin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side R L
- rear
Lot size
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
signs
Fill (volume & location)
6. Narrative Descri tion of Proposed Work/Project: (Use additional sheets
if necessary)ap e. err-vtoda Crcar, new
1 rec rLi 0 G SCCA. eoy
7 . Attached Plans: _etch Plan Site Plan
S . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DaterR/rJ L Applicant's signature: �.(�/ p
T
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
THI9 SECTION FOR OFFICIAL USE ONLY:
F,Pproved as presented/based on information presented
e isd as presented
:;Z 7}s nfoaal:
gna of Hu11spector
Y
D2(tcy
NOTE: leeuenoe of a zoning permit dose not roliwe on applicant's burden to canpiy with dl zoning requlremente and obtain all required permit
ham the Board of Health,Coneemodon Commiesbn,Daperbnerd of Nblk Wod<a end other applicable permd granting authoddee.
7/92 FXAS
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PER IT APPLI�ATTQW EC T
PAGE PLOT lfI ZONE N''1I� YES N DATE
1 . ZONING FORM APPLICATION
2. PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC.# IF NOT
4. 3 SETS OF PLANS OT PLAN
5 . NEW CONSTRUCTION
0 . URB CUT
7 . WATER AVAILABILITY FORMS
8. REMODELING INTERIOR
9 ADDITION
10. ACCESSORY STRUCTURE
AWNING Li
PERMIT12 , - MONEY O D 4- L--
13 .
13 . SPECI L PERMIT REQUIRED WITH DEED IF APPLICABLE
14. UNDER SECTION 1 - CMR 780
15 , FORM A
16 . FILL
i