25C-251 City of Northampton
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Massachusetts
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IlEPARTMEMOFBurznram IIISPECTIONS
212 MAit Street * Municipal Buildinu
Northampton, MA 01060
(D TENT PERMIT APPLICATION
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444pcv/vr, (For Tents over 120 square feet)
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Permit Fee: $30.00 check# IgCfi
PLEASE TYPE OR PRINT ALL INFORMATION
1 Name of Applicant Iff\tlevikt..) 1-.20(109 1").q...4...)
Address: gq 'FCC) OCA4(A-14elephone é7ZD -16;67
2 Owner of Property- ILA*/ 46-Pi
Address: Fi(ft it—)CANi'refftes-- /2779 Tephon 11 Z '5E1-
3. status of Applicant: Owner Contractor
4. Tent Location Addressj- ••• 4
Parcel ID; Zoning Map* Parcel* Districts)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
1
5, Use of Property: Residential Commercial: t (CC-'0 I 901 0
6. Description oi Tent 0°A IC6
1 htO
Size:
9001 60
Occupant Capacity.
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Dates of Use.
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 tru n ccurate to the best
of my knowledge.
DATE: 71//19' APPLICANT'S SIGNATURE
NOTE:issuance of a permit does not relieve an applicant's burde comply with all zoning requirements
and obtain all required permits from the Conservation Commission, Department of Public Works and other
applicable permit granting authorities.
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