1D NIMITZ - BUILDING INSPECTION what is the current use of the Building?
Material of Building? Asbestos?
dwelling,how many unitsT�—
gsbestos?
WR the Building Conform to Law?
tune Guys
Architect's Name A.Boa 4074 t �
Address and Phone P.O o y,
Mechanles Name
Address and Phone
Construction Supervisors LI nse# HIC Registration#
Estimated Cost of Project ace Permit Fee Cakulatbn
Estimated Cost X$71$1000 Residential
Permit Fee i
_ Estimated Cost i11li1000 Commercial-- -- ---An Additional $5.00 is added as an
Administrative charge.
Make sure that all flelds are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building
�Permit to build to the above stated
specifications. Signed under penafly of perjury /�
Date
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20 Q
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PUBLIC PROPERTY
DEPART11EI iT
�umcnsr ota[at
130 WAOUNG cxr Sll{EhT•&U`. UAZAIX{Skrr501970
TM_97L7iS 9S9i'i FNC iM740.96N
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APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING]
STRUCTURE OR BUILDIN(`
1.0 SITE INFORMATION
Location Name: Building:
-- - property - - -
Address;-
-- ------ -- -
Properly Is located in a;Conservation Arse YIN .y Historic Dbbk;t YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Q (ems
Address:
/-0 .A41*1 C7"Z r,J.A�
Telephone: 9-7F- 7Yy- 50G,f
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation
v
Num
ber of Stories Reno
vated
Change in Use o2 New
Demolition Existing
Approximate year of Area per floor (sO Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
e
The Chimney Gu s
P.O. Box 4074
o V.
Mail Permit to: -