8790` AL viNG PERAT
TOWN OF QUffNSBURY No. 879D
WARREN-COUWV,NEW YORK
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PERMISSION is hereby Wanted t4 sley �. lve~r
OWNER of property t*KW at � 3 3 �ticha�el'fd 1`�a��e (�'t. �6� Street,Road or Ave. +
in the Town of Query,To CorwWwtt or place a
Family Dwelling
at the above location in accordance to iapplication togeOW Mrs art,p it and other k0onmtka hereto fW.and l)
approved and in compliance wItIV the To"of Queensbury Wkft and. -Ordk*nce. �
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1. OWNER'SAdVMIs 4 rox, 3Wad-Star lte titte
Glens Fallsa, New York
2. C0tMACT01%;;9WLMR%Nsrm
Woman (Ouellette
3. CONTRACTOR or'BUILOERV Address
28 Lake AV
Glens ra'lls, New York
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4. ARCHITECT'S Name
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S. ARCHITEMS Addrae
EA
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6. TYPE of 00OW00000- 04601&ieaoate X)
K )Wood Frame C i Masomrv: t )lttsel t )
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7. PLANS and
24'x48' per plot 14
nL# specifications and
No. application baiitemd JIWIUd�.ng 00 ar at Ued.
garb and ge , site m.
8. Proposed Use 0
3
One-Fagan i ly Dwelling m
$5.00 C/O Paid A it 1
$ 89.oe PERMIT FEE PAID'—THIS PERWT EXPIRES 19 85 *4
(if a taster period is mcaked en appopatkm for on extenWon rmam lie evade to the Building and Zoning inspector of the t
town of wry befbm the ration date.)
Dated at the Town of Queentbury this 27Tay of I 1984
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SIGNED BY _ for the Town,of Questubury
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