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BUILD TMENT
I IL OF R ROOK AUG — 1 207.E
938 KIN ET RYE B ,NY 10573 9 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
-air _.
FOR OFFICE USE ON 1 yLY: A Approval Date: AU6 8 1022mit#&esA�)_JS8 Application#
Approval Signature: ARCHITECTURAL REVIEW
BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman.
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:Application Fee: %4 S-`!0 jbPermit Fees: -
FENCE / WALL / GATE PERMIT APPLICATION
Application dated: W1r71Z is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit
for the installation,construction,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of
Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code.
1. Job Address: Ek-b �) "I 3
2. Occupancy/Use: S.B.L.#:_/.3 ,, 67S 7 Zone: je-10
3. Proposed Fence/Wall/Gate(describe in detail): I ,
hvCb Doc 6
4. Property Owner: lrl.sIN `'(/f( AAV^ 4
Address: I pHy 1� x Q1�-P� �-1 e &n� 10 l � 0-S�1 3
Phone# N ILI ) D`J��( yCell# email:
Applicant: L1S Pr IjkWi�4Q�s" 6 NAI L.C0^f'
Address: 01 P iLLI.S Q Y7 3
Phone# 6yq)-nz_-LD4 Cell# email: H_<ACA-[tjjP4� j!` UgA0 t-
Architect/Engmeer:
Address:
Phone# Cell# email:
Contractor:
Address&Phone:
5. If building is located on a corner lot,which street does it front on:
6. What is the estimated cost of construction 9 by
(NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and
material and labor which may be donated gratis.)
7. Estimated date of completion:
r
8/12/2021
Please note that this application must include the notarized signature(s) of the legal owner(s)
of the above-mentioned property, in the space provided below. Any application not bearing
the legal property owner's notarized signature(s) shall be deemed null and void, and will be
returned to the applicant.
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
Lr5,'r 4 P( ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the
for the legal owner and is duly authorized to make and file this application.
(indicate architect,contractor,agent,attorney,etc.)
That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use
conducted at the above captioned property will be in conformance with the details as set forth and contained in this application
and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire
Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Sworn to before me this I Sworn to before me this
day of , 200/77P)- day of , 20
///a� A A
Si of Property er Signature of Applicant
LI SR "IA"'t"
Print Name of Property Owner Print Name of Applicant
Notary Public Notary Public
MIKI TAIIRA
Notary Public,State of Now York
No.01TA8107784
Dual"Ied in Westchester Cou�ntyn�
^,ommisslon Expires Anr. 05,20i
2
8/12/2021