5 PALMER ST - BUILDING INSPECTION (2) EPPY-OF
PUBLIC PROPERTY
DEPARTMENT
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Navas r 30 WwswNGfM hIUM•&MNy wsunnsr�ns or97o
TIM M745.9S"0 FA=M7404M
APPLICATION FOR THE REPAIR RENOVATION_ CONSTRUCTION,
DEMOLMO—N-a OR CHANGE OF USE OR OCCUPANCY. FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 317E INFORMATION
Location Name: Building:
Properly In located In a;Conservation Area YM Historic Dbtrltx YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land `
Name: ALL lAIAI
� C
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EYMTM BUILDINGS ONLY
Addition Existing ��
Renovation umber 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
add Description of Proposed Work:
What is the current use of the Building?
Material of Building? ifdwelUrg,how many units?
Will the Budding Conform to Law? Asbestos?
Am~*Name
Address and Phone
Madtanids Name R c c (4 A r 1) y)/�! 401 Gn
Address and Phone 3 /11 /> Kph/ A ex- 6-6646119
Constiuction supervisors License 0 a 3 PWO HIC Registration N. /SfSG�
Estimated Cost of Projed$�� Permit Fes CaleuMM
Permit Fee i Estimated Cost X$7/51000 Residential
Estimated Cost s11n100O Commercial-------- -
An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build limthe abovA stated
specifications. Signed under penalty of perjury
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