23B-046 (272) ,3 (3r6'IrO
City of Northampton
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Massachusetts DEPARTMENT OF BaZLDZNGPal Building 212 Hain acreet • MuMici 1 Bviltlin9N NortFampcan, nA 01060 TENT PERMIT APPLICATIONH (For Tents over 120 square feet)OPermit Fee: $30.00 Check
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant. f T --5� /1 S �(��(rt:
Address: ���� Telephone: J7-V1�
2. Owner of property: C/onlet-/ c 4"/ -,�l ' ays67e / �Tp/
Address. 7 L-, G C 0 J T / Telephon ��+ /
3. Status of Applicant_Cerner _Contractor
4. Tent Location Address}. Jo L nt6 G UJ T s
k 0 (' Mc C'Cclko? yi/�Th9
PafcellD: Zoning Map# .Parcel# Districts)
(TO BE FILLED IN BY THE BUILDING.DEPARTMENT)
5. Use of Property: Residential_ Commercial
6. Description of Tent: I
size: 30 x�ZD/
Occupant Capacity. /00
Datesof Use: WEA), JUnC 20��
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: ��- /0 APPLICANT'S SIGNATURE
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.