HomeMy WebLinkAbout51694-Z TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 ht s /w ut oldtownn . cry
Lake Received
APPLICATION FOR BUILDING PERMIT
For Office Use only
PERMIT NO. to Building Inspe�cton
JAN 1 0
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Date:1/9/2025
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Name:Laaudis of Southold LLCp cTM#1000-
,
61. 4-22
Project Address:54280 Main Rd. Southold NY 11971 e
FPhone#:973-278-4148 Email;gin@rnlwiac ►rng Address:PO Box 579, Alpine, NJ 07620
��.P �� O "
Name:Amanda Starks
Mailing Address:
PO Box 728 Southold N
. .._ ... _ .. . Y 11971
Phone# 51 6 603-0550 Email: ma tt esde ignstudio.com
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Name;Arnanda Stark.
Southold NY 11
Mailing Address: 971
PO Box 728 South, w
Pho 11 ne#-„516-603-0550 Email:amanda@nicolettesdesignstu
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Name:Kevin Quarty
Mailing Address:PO BOX 1949 Southold NY 11971
Phone# - y nstrU
381 3137 Email:
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E IN er tructure Addition WAlteration oRepair ❑Demol'ition„ Estimated cost of
Project:
h 10,000
Will the lot b
o
e re-graded? ❑Yes ®No Will excess fill be removed
from premises? ❑Yes ®N
1
lalllr* rIr: N �ari m.
Existing use of property: Intended use of property:
_ _ Fitness Center.. _. - Retail
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Ham*'Iet BUSineSS District this property? ❑Yes �No IF YES, PROVIDE A COPY.
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Application Submitted By(print name):Amanda Starks ®Authorized Agent ❑Owner
Signature of Applicant: Date: 1/9/2Q25
i«ONNIE D.BUNCH
Notary ubli ,State of New York
STATE OF NEW YORK) o,01BU6185050
SS: Quallfied in Suffolk County
COUNTY OF Suffolk �` ) Commission Expires April 14,2�
Amanda Starks being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Tenant
(Contractor,Agent,Corporate Officer,etc.)
of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this J J�
day of �`- ,20 2 S fw� fV
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I Theodore Laoudis residing at 226 Getty Ave., Paterson, NJ
o hereby authorize Amanda Starks
to apply on
my behalf to the Town of Southol BuildinDepartment for approval as described herein.
w "�t 01/09/2025
Owner's Signature Date
Theodore Laoudis
Print Owner's Name
2