8569 BUILDING PERMIT
TOWN OF QUEENSBURY 8569
No.
WARREN COUNTY, NEW YORK
N.
PERMISSION is hereby
granted to William F. Miller Y
N
OWNER of property located at Elm Road, Glen Lake Street,Road or Ave. M
in the Town of Queensbury,To Construct or place a One-Family Dwelling — Demolition of camp
at the above location in accordance to '',application together with plot plans and other information hereto filed and P•
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. Ira
N
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1. OWNER'S Address is 12 Edgewood Drive
South Glens Falls, New York
2. CONTRACTOR or BUILDERS Name
same
3. CONTRACTOR or BUILDERS Address
same o
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address h
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6. TYPE of Construction—(Please indicate byi,X)
IN Wood Frame 1 )Masonry ( )Steel ( )
7. PLANS and Specifications
Demolition of present camp.
No. 321x36' dwelling with 2 car garage under per plot plan
specifications and application submitted including o
8. Proposed Use sewage system',. Per Var.. 911 0 m
One-Family Dwelling - Demolition present camp "13
rt N-
$5. 00 C/O Paid10,
$94. 00 PERMIT FEE PAI —THIS PERMIT EXPIRES January 1 19 85 : O
(If a longer period is required an applicat on for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expir rtion date.) t✓
Dated at the Town of Queensbury this 14th Day of June 19 8* :•
SIGNED BY af�OiD for the Town of Queensbury
Bui ing and Zoning I