8101 BUILDING PERMIT
TOWN OF QUEENSBURY of
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WARREN COUNTY, NEW YORK it
PERMISSION is hereby granted to Walter Dombek
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3 S'
OWNER of property located at _ TIC* I-Stephanie Lane (St. #k l) Street,Road or Ave.
in the Town of Queensbury,To Constructor place a Ones' ily Dwelling
at the above location in accordance to application together with plot plans and o0w information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
Lake George, New York N
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2. CONTRACTOR or BUILDERS Name
Tim Chase ro
3. CONTRACTOR or BUILDERS Address
Box 62 tD
Glens Falls, New York r'
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4. ARCHITECT'S Name
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5. ARCHITECTS Address
}vey
6. TYPE of Construction—(Piease indicate by'X)
(19 Wood Frame ( )Masonry 1 )Steel ( ) "
7. PLANS and Specifications 0
24 t x42.t per plot plan, specifications and
No. application submitted including sewage system. �
8. Proposed Use
One-Family Dwelling �c
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$5. 00. C/O Paid
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$70. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 1 19 84
(if a longer period is required an applicaton for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 16t h_ Day of September 19 83
SIGNED BY for the Town of Queensbury
Bulk hg and Zoning inspect