application OFFICE USE ONLY //.���
TAX MAP NO.3O j (n- / !- � d PERMIT NO._ I3'f_l._�U Date
FEES: PERMIT C (RECREATION ' s
-_ENGINEERING ~t
(If applicable) t{ {
Era.I_t_20 r3.
PRINCIPAL STRUCTURE:
APPLICATION FOR ZONING APPROVAL & BUILDING
IT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS JEERO REVIEW
BEFORE ISSUANCE OF��AA VALID PERMIT( FOR CONSTRUCTION.
APPLICANT/BUILDER:jAar K f-t-}e\\Jee_ OWNER: i`..0,
ADDRESS:' O �c\nae\5 it i. 0 b Ann\J���
ADDRESS:
PHONE NOS.5 , - 745- 8-5c0 5-tT- 361- 337rPHONENOS. 555-596 - RTCC
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE:
PHONE:
LOCATION OFPROPERTY:Q 7 Bia 756 U eger-6- eve 5i. Qby 412_
HAS THERE BEEN A SITE PLAN REVIEW; VARIANCE OR SUBDIVISION APPROVAL? 0 YES 0 NO
IF SO, INDICATE APPLICATION NO.AND DATE OF APPROVAL:
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT z
APPLY TO YOUR z re 0 I-
PROJECT 0 < 00 -j 2 LL w
z ¢ ¢ �:- co vQi ~Ori ccD. w �
� � axar
SINGLE FAMILY
TWO-FAMILY
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE
RETRE AIIANTILE L- vCJof er .3a ,tri 1- IU, , x30,b9
FACTORY OR l
INDUSTRIAL
ATTACHED
GARAGE(1,2,3) `1' kiO
OTHER
IF fV1MMCorm At netmint le��..... 1� _ \ I A
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN?
ARE THERE EASEMENTS ON PROPERTY?
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete statement/description of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning regulations. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand
that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and t e
Signed
Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction codes
or septic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
Permission is hereby granted to the above This application / proposed action described
Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said zoning Laws of the Town of Queensbury.
Application:
I
BUILD NG COTES APPROVAL ZONING APPROVAL
3 / 3
DA E DATE
J
QUESTIONS 7 CALL 7614256 OR EMAIL
codes(Thausanshunr_not