3A NIMITZ - BUILDING INSPECTION What is the Current use d the Building?
Material d BuildIM? If dwelling.how many units?
will the Buildl V Conform to Law? Asbestos?
The Chi-:;: Greys
ArolutacCa Na" 1
Address and Phew
Medwdes Nww 978-977-9900
Address and Phone HIC Regbtrarion 0
Construdon Supervisors L.Wanee 11 —
Estimated Cost m Perna Fee Cale
Permit Fee S Estlr X$7/natad Cat =7f:1000 Residential
--- - EstlrnaEsd Cat x it tl:1t>Dp Canrneroia�— -An Additional$5.00 is added as an
AdminMmdve charge.
Make sun that sY}lalds are property and legibly written to avoid delays In Processing.
The undersigned does hereby apply for a Building PanrA to bu the above stated
speci0cationa. Signed under penally of Penury
Date S' a
of
N
GrrTU1T5.�.E,� .
PUBLIC PROPERTY
DEPARTIMNT o
IJ.1yEfalY rowrr ; ,62 1 t•sfitr /i,e'I '&J'
MA1IOt i M'•ii -..;1 f 2 3-
130W�fWtwlcwftwe -0Su^ Sr7R01w*
T=-9,&iis_iS •FDIC l7e:7g9are
APPLICATION FOR THS REPAIR. RENOYAUQN ONSTRUC nON
DEMOLITION. OR CHANGE OF USt OR OCCUFA Cy yog Ny �--p G
STRUCrM OR BLirLDiNG
1.0 SITE INFORMATION
Location Name: �' 8uilding:
Property Addrew
Properly is kl r I 'Ins:Conservation Ares YM H' -m 'n Didit YIN �
2.0 OWNERSHIP INFORMATION
9.1 Owner of Land
Name: -
CT.,/' Q G o.
Address' 3` 6\/ir1 G L-j c �
Telephone
3.0 COMPLETE THIS SECTION FOR WORK IN EV'21'Nr1 BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor(sfj Renovated
Construction or renovation
of existing building New
add Description of Proposed Work: /
�T SA// Klzf >6
The Chimney Guys
- - - - - -- F A 1,Hex 4074
Mail Permit to: Peabody'MA 019611`
0799