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2012-020 TOWN OF QUEENSBURY 742 Bey Road,Queensbury,NY 12804-5902 (310)761.8201 Community Development-Building&Codes (518) 761414% BUILDING PERMIT Permit Number: P20120020 Application Number. A20120020 Tax Map No: 523400-309-009-0002-001-000-0000 Permission a hereby granted to: DIANE SHUTE For prop"located at: 200 LUZERNE Rd in the Town of Queensbury,to construct or place at the above location in occordence with application together with plot plane and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Vie• 'There of Construction Yam Owner Address: HOMESTEAD VILLAGE L P Mobile Home In Park $13,000.00 4294 ROUTE 5 Total Value $13,000.00 CALEDONIA,NY 14423 Contractor or Builder's Name/Address Electrical Inspection Agency Plane&Specifications BP 2012-020 Diane Shute: 110 Adirondack Street 924 sq. R. mobile home,year 1991 model: AmberRidge The Mobile Home is located in Johnson,Vermont. Maurice Combs will move the MH from Vermont to Queensbury. $110.S8 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,January 24,2013 (if a looser period is required,an sppliesdoo for an exes lion must be made to des code Enforcement Officer of the Toro of Queembury bdom des expiration due.) Dated at the Town oury, /J Wonr 24,2012 SIGNED BY 7�j/ V- for the Town of Queensbury. Director of Building&Code Enforcement