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448 TOWN OF QUEENSBURY Warren County, New York Office of the Zoning Inspector APPLICATION FOR A BUILDING PERMIT Location of Property. C'.:!f:::. . .:`: �. . o . . . . . . . . . . . . .Road,Street or Avenue 147) Owner' s Name and . . . .( ;; ./ :�-�:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address �� 3 Cam - C/h . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Architect' s Name and Address . . . . . . . . . . . . :: .®!�':: ::. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Builder' s Name � ©���� and Address . . . . . . . • . . . . . . . . . . . . . . • • . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (I,*asonrT. . .( . .) . .Wood Frame ( ) Metal Type of Building (check one . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Building to be . . . . `:. .Feet Wide. . . . i . . . .Feet Long. . . ./. . .Stories High Estimated Cost of Building. . . . .G.:'.: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Proposed Use of Building. . . . . �! 0 9 0 0 0 .::{ . '.:.� 0 0 . . . . . . Are There Any Other Buildings on the Premises?. . . . . . .;f:_l. . . . . . . . . . . . . . Is Any Existing Building to be Demolished?. . . . . . ��:. :. . . . . . . . . . . . . . . . . . ( ) New Construction ( ) Repairs ( ) Remodeling Is the Work (check one) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Three copies of a plot plan drawn to scale showing the actual dimen- sions of the lot to be built upon, the exact size and location on the lot of the building and accessory buildings .to be erected are attached to this application. The undersigned hereby agrees to comply in the said construction with all the provisions of the Zoning Ordinance as adopted, of the Town of Queensbury. (If permit is granted it will be on condition that building or al- terations shall be completed at date to be fixed by Zoning Inspector, and if not so completed permit shall be revoked by him. ) REMARKS : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . I hereby agree that all work and materials will be in strict con- formity with the laws governing building in this Town, and further agree to post conspicuously a copy of the Building Permit, protected from the weather, on the premises affected. ;�z � n (� ((�� ` � � . . . . . . . . . . . . . . . . . •TO• f� W QL�'ENS3URY !� Y I�a,O V 6_. ® (Signature) RD_ D DATED 28 196) p.m. 7j81911111111, 1I2I3I�15�6 BUILDING & ZONING INSPECTOR Vwne " " " " ' • ' ' ` •`• • " ' " ' TOWN OFOUE.ENSBURY , Contractor, Archite�tor agent ike out inappropriate Provision) ' Date Filed 19 h v