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Office Use Only ih Hu)iQ=<)7 tay ton,Queensbury,NY 12804 ||||Fa 13 2000 P:518-761-8256 www.queensbury.het Project Location: Tax Map ID #:4-\-28. CONTACT INFORMATION: .\pplicallicant: Name(s):K Mailing Address,we lo Ext Fp. Cell Phone:yo a Email:cid =Paciermerchom @ easennecharn oldings .com ¢Primary Owner(s): Name(s):SAME AS PPPUCANT Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: ©Contractor(s): Business Name:SAME AS APPUCANT Contact Name(s): Mailing Address,C/S/Z: Cell Phone:_()land Line:_() Email: ©Architect(s)/Engineer(s): Business Name:_FUONSVA AS peaditecute Contact Name(s):ABN P.Yau Maling hess C72 4 Dix Ne GieNsS Fars Nt 1200\ Cell Phone:Land Line:(SI _) Email:ephall @ngcap:wy.COM Contact Person for Building &Code Compliance:Faun P.Deu. Cell Phone:Land Line:(A\O_).Go epvia \enucaperce nycayp-Email:8Duca -1C.Com. ‘Town of Queensbury Building &Cade Enforcement ‘Accessory Structure Application Revised April 2017 o PROJECT INFORMATION: TYPE:commercial _____Residential WORK CLASS: __Deck,Open Porch Solar Panels (w/o rafter upgrades)__Carport __Cell Tower __Shed __Pavilion,Pole Barn,Canopy Dock __Gazebo Detached Garage ___Boathouse (with or w/o sundeck)__3-Season PorchiOther(description:MML Qo0M +UMLITIES Foe.sre SQUARE FOOTAGE OF STRUCTURE: ist floo:_ZA SE . 2 floor:_— Total square feet:ZAOQEADDITIPRINFORMATION: 1.Estimated Cost of Construction:$_|Q,Q00 2.if Commercial project,what is the proposed use:_ANAL Yor.ANTS 3.Are there any structures not shown on the plot plan?YES (NODExplain: 4,Are there any easements on the property?a)ECLARATION: 1.1 acknowledge that no construction shall be commenced completed within a 12 month period. to issuance ofa valid permit and will be 2.Ifthework is not completed by the 1 year expiration date the permit may be renewed,subject to fees and department approval. 3.|certify that the application,plans and supporting materials are a true and complete statement and/or description of the work proposed,that all work will be performed in accordance with the NYS Building Codes,local building laws and ordinances,and in conformance with local zoning regulations. 4.|acknowledge that prior to occupying the*facilities proposed |,or my agents,will obtain a certificate of ‘occupancy. lalso understand that |Ave are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of acertificate of occupancy. Ihave read and agree tothe above; PRINT NAME:AGENT foe We AAUANT vate: 13 HB D2 SIGNATURE: ‘Town of Queensbury Building &Code Enforcement Accessory Structure Application Revised April 2017