160 160
June 20 i 1968
R.D. I Lake George
Town of.,.Queenpbury , .
Same as above
. ,An addition an-an. existIng, Mobile Home-
XX Additional living Space
RX=tKXIJ1IaM NWA#iwif Owner
XXLXUXXKXMXM.
I 10 1 t
fl, a%vt. $p 0,y- a 0 ,o a
thze 4!,bove rm'oe:r foz tht,: roa-
of s lluflett%,, rw
Na
k -� trnt ,& t o�ne, ,
10.00
i-0=it-li-inspecto
r I
Form # 4
TOWN OF QUEEN5®URYR TOWN OF QUEENSBURY ^
0 E � V E a
Warren County, New York
SUN 18 1968 Office of the Zoning Inspector
A.M.
g 1 111� 1 2 8 4 6 PPLICATION FOR A BUILDING PERMIT 193
Location of Property./ G•�♦rL�♦ • /. . . ♦ ;P; • , , , , ♦ , • , ,Road, Street, or Avenue
Application No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed. . . . . . . . . 19. . . . . .
Plan No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . .Permit No. . .
Own er. . . . . . . . . . . .
Architect. . . . . . . . . . . . . .
Builder. . . . . . . . . e�����N ir'• . - ,• ela!'.r-i 1!�
. . . . . . . . . . . . .1 . . . . .
Type of Building. . dl. .' . . : .4iCe51�H �i/ •� ,e
.� .
Building to be. . : p. .Feet Wide. . : 1°``d. . .Feet Long. . . . . . . .Stories High
�• x�.o
Estimated Cost of Building. At , , , • , • , • • , , , • • , • , , , • , ♦ • . • . . .
�7 ,�-. �/ / Q�
Proposed Use of Building. . . . . . .-'14.. . :° :!l0:0�<,,J�:of,2�f�!r�h ? ?
Are There Any Other Buildings on the Premises?. . . .IV."Xlf. . . . . . . . . . . . . . . . .
C
Is Any Existing Building to be Demolished? . . . . iqi. . . 10:t D , • , ,
Is the Work New Construction, Repairs, or Remodeling?. . . . . . . . . . . . .
Date Building Permit Shall Expire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. . .
Three copies of a plot plan drawn to scale showing the actual dimen-
sions of the lot to be built upon, the exact size and location on the
lot of the building and accessory buildings to be erected are attached
to this application.
The undersigned hereby agrees to comply in the said construction with
all the provisions of the Zoning Ordinance as adopted, of the Town of
. Cueensbury.
(If permit is granted it will be on condition that building or al-
terations shall be completed at date to be fixed by Zoning Inspector,
and if not so completed permit shall be revoked by him. )
REMARKS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
• . • • • • • . • • • • • • • • • • • • • • • ♦ . • ♦ ♦ • • • • • • • • • • • • ♦ • . • • • • • • • • • • • • . ♦ • • ♦ • . • • • • •
• • . • .-• • • • • • • • ♦ • • • • • • • • • • • ♦ • . . • • • • • • • . . • • • • • • • . • • • • . • • • • ♦ . • • • • • • • • • .
I hereby agree that all work and materials will be in strict con-
formity with the laws governing building in this Town, and further agree
to post conspicuously a copy of the Building Permit, protected from the
weather, on the premisies affected.
(Signature)
- cm I e s 5l d9� r• :7`' i'�d
l
if Fla
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Owner CQ , A&e44t-c� .&r--ASt t"t
(� (strike out inappropriate Provision)
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