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180 NORTH ST - BUILDING INSPECTION (2) GITY-OF�ALE;� _- PUBLIC PROPERTY DEPART?vj NT �i.�a��oiuscou. �Gvoa r 30 VirwsMlNc'�oN�����.LLti11�(.�ss�on:sti»s OI970 TEL•9'.L71i9S9S#pA3D 97L7404M APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION DEMOLPPION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: Building: Address lei No 2-r14 ST S >41�M - Property l•bcaw in a:Conservation Area Y/N 11_HWorlc OleMot Y/N [Address: .0 OWNERSHIP INFORMATION .1 Owner of Land AL)Z �,4C�/�(/j ame: `3 p Ho v '1 E v`T'. f3 Ev E2L MA . a 11/,- Telephone: -,5oW &535 Oy' $65- PLETE THIS SECTION FOR WORK IN EX19tZING BUILDINGS ONLY Existing ion Number of Stories Renovated in Use Near rFf n Existing ate year of p��U Area per floor (sf) Renovated ion or renovation / building New Brie(Description of Proposed Work: 13vlc.d� �fll � RAAIP — Mail Permit to: 3 6 ffoq4tv �i �2CsIDE�i// — What is the current use of the Building? if dwelUng.Flow many units? I Material of Building? �A)ODo Y "it the Building Conform to Law? Asbestos? ArchileasName Address and Photo Mechanic's Name S Addross and Photo HIC epfatrationli Conoxc6on Supervisors Ucense 0 Estimated Cost of Project S © � Pemrit Fee Calwlstbrr permit Fee l , Estimated Cost X$71$1000 Residential --- Estimated Cost X Si ii$1000 Cammerets4--- - - - An Additional$5.00 is added as an Administrative d+aro.. Make sure that all fields are property and legibly written to avoid delays in processing. The undersigned dose hereby apply for a Building Permit to build to the above stated specftawm. Signed under penalty of perjury Date �0�o-? V\ ^r ISS O r y b ` E- •� v° o�° L �