25C-251 (127) f " 65 )- ),o - 6C/ �
City of Northampton d I
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Massachusetts °'" cot` L
DEP TMENT OF BUILDING INSPECTIONS �
212 Main Street • Municipal Building J
JUL 2019
Northampton, MA 01060 ♦�
1 6
NORTrrq,,p7ON.IMA01"PE0600N$ ENT PERMIT APPLICATION
(For Tents over 120 square feet)
Permit Fee: $30.00 Check #
PLEASE TYPE OR PRINT ALL INFORMATION
1. NE me of Applicant: Lk,) non�yelo 4n-oq '�vyj
A ress: 91 AM ` J„� T-D 00tt)Te)WA)f� Telephone: Do-/gSy
2. Ov ner of Property: (ren ,8
A ress: !� _ FAO , 4 A.24�4tjlY C _Telephone:
3. St us of Applicant: Owner Contractor .!! ip
4. Ter t Location Address):- ��� ��-►'�
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IN
5. Use of Property: Residential: Commercial: n (�
6. Des ription of Tent: a rr���,, d` a KJ lcc-'
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Size. 11 ,fJ �(d✓ ��� ��60
ccupant Capacity.
ates of Use: C?
7.
7. AL INFORMATION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
8. Cer ification: I hereby certify that the information contained herein is true and accurate to the best
of y knowledge.
DATE:-'I APPLICANT'S SIGNATURE -1 - 0
NOT : Issuance of a permit does not relieve an applicant's bu comply with all zoning requirements
and twin all required permits from the Conservation Commission, Department of Public Works and other
applic ibis permit granting authorities.