11 PARLEE ST - BUILDING INSPECTION (2) What is the current use of the Inca?
Material of Building? �vaD V f n If dwsiUM how many units? —
WIN the Building Conform to Law? i s - Asbestos? D
Architect's Name
Address and Phone ( j
Mechanids Name
Address and Photo
Construction gupervisars License y HIC Registration y
Estimated Cost of Project S UO D Permit FN Calculetlort
Permit Fee: Estimated Cost X S71S1000 Residential
Estimated Cost $41/$1000 Commercial-
An Additional S5.00 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 to the above stated
specifications. Signed under penalty of perjury /\
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PUBLIC PROPERTY
DEPARTMENT L
%rwroa 130wwswrw- M URM•
3%tjK Y,Vawou%-M ots7o
APPLICATION FOR THIC REPAIR. RENOVATION. CONSTRUCTION.
_0114MOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
l.ocatlon Name I / a r/.e-g Building:
py�ny -----
Properly In located in s;Conservation Are@ YIN Hlstorte 01skict YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: TGt MSS a
Address: 6pal-1-ee SQL
Sab-LeY "A
Telephone: / �j 7 e 7 — ll0
3.0 COMPLETE THIS SECTION FOR WORK IN EYISILIM 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 New
Met Description of Proposed Work:
"q , Each d / / X a o ��c•�
Mail Permit to: i C