5787 BUILDING PERMIT
TOWN OF QUEMSeMy
No.
WARREN COUNTY,;10WYORK
PEf MISSft'Uis hwebyw to John M. De Lisle
MONIER of#arty loc&tetl at 12 Phillips Ague Sbv t,flood or Avq.
in**Tovm of QueMwxwy,To con*gnwt or phm a i t$on t4 dye l l {
at d>t abovri-focatIon in b .. ,
inn �'� plot prtans and aOw k*errnfaiwn(wer#rto fihd and_--
approwd a+W in m optia m vfh du Tovrn Of Ojewabury Bulkift oxf Zoning Ord4unce.
ToI 'SAd*wis 12 Phillips AVen
Ue
Glens Falls, N.Y. i
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2. C014TRACTO R or EUI LDER°S Narne
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M
I CCWMACTdR or'iGLDER'S Address
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4. ARCNITECT'8 Nan.
5. ARCMTECT'e Ad*ow
TYKE of ConwwcdDn IP%m indkm"by XI' {
(X)Wood FrSM f 1 MUDWy I i SOW
N. e
V
9. KAN$ow ons M
'12 x24
nb. per plot plarsR $peciflctttan8 And APPli,cAtiOn c
subm tted, �
S.
One-ramily Dwelling. ( tuna?. ling area)
$5.0 CPaid
1 .
$ 14,@Q PERMIT FEE RAID—THIS'PEf1MIT 1sXPtRES. 1$79
Dated at the.Townof Qumisbury this loth Day of MAY 19 79
O
SIGNED BY . for the Town of Qaeensbury OA
- Buis a4d Zontt�y 1 1-+ f
' y C
C� lds
C/O Paid
CERTIFICATE OF OCCUPANCY
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 19 _
This is to certify that work requested to be done as shown by Permit No. 5787
has been completed..
This structure may be occupied as a one-Family 'Dwelling CAd(*t.tonal.
1.2 Ph flips Ave. Livt.ng Area)
LocMiast
O
By Order Town Board
TOWN OF QUEENSBURY
Building & Zoning Inspector
C*CATIV[ -100STA" PRINTING. OL[Nf IALL3, N T 12601 15101793.5490