16A-002 (14) City of Northampton
Massachusetts £
�AR " a Wry=e0 >asPsorj
212 � atz6et • r6miaip� aeil W
gottbup , N6 01060
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TENT PERMIT APPLICATION
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HI
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(For Tents over 120 square feet)
Permit Fee: $30.00 Check# 3/&/
PLEASE TYPE OR PRINT ALL INFORMATION
1. Nameof Applicant CkAsr 6a. /4gB_r SG6T-n YM FEs T-iV -L INC.
Address: 'Po.60,< ,%, BLarrn FDff), Ha 01008' 7alsphere:
2. Owner of Pmpelty: L001c11+0_1<
Address: 300,300 10"wer N1 Telephone: 4l3 -SAY SYT9
3. Statue of Applloant_Owner _X—Con6ector n�
4. Tent LOOatlon Address): �OX y IhLA' I 1 ,kr9V /�tC F(pL{�
5. Use of Property: Residentlel:_ Commercial:X
S. Desaiptlon of Tem:
Size: *d r X PO ,
Occupant Capacity UP Kpw A/
Datesofuse: JyLT ?l, Zo18 To SE a-T up 71201/P)
7. ALL INFORMATION MUST BE COMPLETED:PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
& certification: I hereby certify that the irrfell stion contained herein is true and accurate to the beat
of my knowledge.
DATE: . APPLICANT'S SIGNATURE 4
NOTE:lesuance of a Permit does not relleva an applicants burden m comply with all mning lequken a rrh
and obtain all required pennka from the CorBervallon ComMesbn, Deparhnarrt oaf Public Works and odler
applicable parmk granting authorities.