48-013 (2) City of Northampton
Massachusetts
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DEPARTMENT OF BUILDING INSPECTIONS Z,
212 Main Street • Municipal Building �D
Nor.tj on, ISA- 1060
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TENT PE APPLICATION S�F°Qn�� �� �T ) �e
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g ell--��� � Pc-0 i=(.f}i''1L� 1 N r�-►�rl� �5 -rte
AlleC r Z_F /1A-r�v /44_19?VV-
(For Tents over 120 square feet) Apo .6 GET C-0 0&-TL -Ibe5
Permit Fee: $30.00 Check # `167 /F�-c4U5c6- 7-p1&-C w«, /3=:-
V5 5 i rvG TL-"uf Hrf�T�`125.
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address L Oy0Vr LLE r ZA. Telephone:
2. Owner of Property: /'/gT/1 �'C n� ^� '�L' �- S!g .i ✓� L*✓3
Address: 41 o f�9 i sT /ate igr�a+ .ib 6.4 ,M4elephone: Sog
3. Status of Applicant: Owner Contractor
4. Tent Location Address): -7 __1 L 6 v,py i I,t6 /L✓J 1.1 6/LTM M,07"t rJ 1,1A
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLEDINBY THE BUILDING DEPARTMENT)
5. Use of Property: Residential: r/ Commercial:
6. Description of Tent:
Size: - I a X z o t n 2 f oA7- 7-aW7'S
Occupant Capacity: `10
Dates of Use: 12- /6 — I z/y
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: �- ! y APPLICANT'S SIGNATURE z�
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.