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FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO.
31221 Z
Date JUNE
22, 2005
permission is hereby granted to:
LUCILLE BETTINARDI
389 NW 95 AVENUE
PLANTATION FL, 33324
for :
VOID PERMIT
VOID PERMIT
at premises located at
330 WATERS EDGE WAY
SOUTHOLD
County Tax Map No. 473889 Section 088
Block 0005
Lot No. 051
pursuant to application dated JUNE 20, 2005 and approved by the
Building Inspector to expire on DECEMBER 22, 2006.
Fee $
1,783.20
'-
Authorized Signature
ORIGINAL
Rev. 5/8/02