2B NIMITZ WAY - BUILDING INSPECTION —Crry-o'
PUBLIC PROPERTY
DEPART1VitENT
MAWS 130 WA20NGTCW STWW f*swK MAsaAo.:srrs 01970
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AFPL CATION FOR THE REPAIR. RENOVATION_ CON_-CTRUC33A111_
D&MOLM014,OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTn Q
STRUCTURE OR BUU&MG
1.O Wn INFORMATION
Location Name: Buildkt¢ ✓�
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Property M loafed in a:Conservation M Hkdorlo okuid YIN
2.0 OWNERSHIP INFORMATION
2A Owner of Land
Name: 45
—
Addreas:
a �
Telephone: -7 o
3.0 COMPLETE THIS SECTION FOR WORK IN E7(19I1 W BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor(sf) Renovated
construction or renovation
of existing building I I New
Brie!Description of Proposed Work:
The Chimney.Guys
- —— —Peabody,-M-A-04%0 -
---—- ---Mail Permit to: 9 78-91 - --
What bs 0»Current use of the Building?
Material of Building?
it dwelling.how many unQs?
WIr the&Acw g Comm to t aVA aey -"y` Asbestos?
greh*ecYs Name Box 4074
Peabody,MA 019bu
Address and Phone
titeehanlds Nam
Address and Phone
Construction Supervisors License 0 HIC Regiatretlon 0
Es*nmd Cot of Project i O-C> Penult FN Cal X$71ermit Fee: EsOrnated Coast 7Is1000 Residential
P
Esdrnatad Cot X 4141/411000 Carr mwcisl
An Additional $5.00 IS added as an
Adminlstradve drrgs.
Make wrs that all Flelds am property and legibly written to avoid delays In processing.
The undersigned does hereby apply for a Building Perm*to build to the above stated
spec&AtWm Signed under penalty of perjury X —�
Date icl,
of
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