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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