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APP # �- <br /> Date d'{- <br /> (for office use only) <br /> CITY OF PEQUOT LAKES <br /> BUILDING PERMIT APPLICATION <br /> Name of Applicant i_.u,rr R• 4 W e Phone 2-i <br /> Mailing Address P,D B o x &3 3 Email e <br /> City, State,Zip __ N i s s 1NC(, MA) S; f to 8 <br /> Applicant is: Title Holder of Property: <br /> Legal Owner L-a*-r y A• t I Ne- A� ! M• F <br /> Contract Buyer () (Name) <br /> Option Holder () —5a vv-e,, <br /> Agent () (Address) <br /> Other <br /> (City, State,Zip) <br /> O7 <br /> Signature of Owner, authorizing application(required <br /> (By signing the owner is oectifymg that they have read and understo4the tru ctions mwanying lic atiom) <br /> Signature of Applicant(if different than owner): <br /> (By signing the applicant is certifying that they have read and understood the instructions a000mparrying this application) <br /> Location of property involved in this nreq e st: <br /> �'1 Gv cc +�, P-v (0-7 'P1f f La�lr-e—s <br /> Fire No. ,Parcel ID No,�Iq iQ a-l-,YLI M 4 11 164 9 <br /> Zoning District le k <br /> State nature of request m detail: (What are you proposing for the property?) <br /> m <br /> i v. o wv' s W-r— CO-W <br /> ,i f-1 C w-tr <br /> t Cc,L4,AJ L t4 iN2 P� sivv� <br /> P.v- ve I <br /> la U= <br /> Approved by the Zoning Department: Date: <br /> REV: JAN 2002 <br />