AST-0020-2022 r
Office Use Only
ACCESSORY STRUCTURE Permit#: O O y—Zo2Z
PERMIT APPLICATION
Toxin aCQuecvsbury Permit Fee: $ ��-
742 Bay Road,Queensbury,NY 12804 D EC E 0 vfE ice#:
P: 518-761-8256 www.gueensbury.net d Zone? Y Reviewed B 'D
EJAN 2 5 2022C�
TOWN OF QUEENSBURY of bq- 20Z1
BUILDING 4 CODES
Project Location:
Tax Map ID#: �(,g + —I - Subdivision Name:
PROJECT INFORMATION:
TYPE: Residential ❑ Commercial, Proposed Use:
STRUCTURE:
❑ Boathouse (with or w/o sundeck) ❑ Canopy Carport ❑ Cell Tower ❑ Deck
❑ Detached Garage (>300 s.f.) ❑ Dock ❑ Gazebo ❑ Pavilion ❑ Pole Barn ❑ Porch ❑ Ramp
❑ Shed (<300 s.f.) ❑ Solar Panels(w/o rafter upgrades) ❑ 3-Season Porch ❑ Other:
SQUARE FOOTAGE OF STRUCTURE:
1st floor: '
2nd floor: Q
Total square feet:
Brief description of scope of project:
Accessory Structure Application Revised January 2021
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CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Z4,0%�Y T ordc„,
Mailing Address, C/S/Z: 104 5L ns—F- `L`l
Cell Phone: 607- 43 ti-13 4 3 Land Line:
Email: 2J""4J" S'i10 y".4, ,Lvw,
• Primary Owner(s):
Name(s): �7cv��c,-y ��d(c ,,
Mailing Address, C/S/Z: tort 5un5e-F +1c vL4, ( ')Fv `{
Cell Phone: (,oj. - L3 5 ) 4 3 Land Line:
Email: Z Joy-dC-.. 84�L0 r4AC."Icu_n
iz�leck if all work will be performed by property owner only
• Contractor(s): (List all additional contractors on the back of this form)
Contractor Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
• Arch itect(s)/Engi nee r(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for any questions regarding this project:
Cell Phone: Land Line:
Email:
Accessory Structure Application Revised January 2021
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104 Sunset Trail 1
Carport