56C PICKMAN DR - BUILDING INSPECTION What is the Current use of the Building?
Material of Building? If dwelling. how many units?
Will the Building Conform to law? Asbestos?
Architect's Name
Address and Phone 0-7S/ 0,7
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project S Per ft Fee Cak:uwm
Permit Fee S Estimated Cost X$7/$1000 Residential
Estimated Cost X S11/$1000 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 to the above stated
specifications. Signed under penalty of perjury X
Date
1
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---- CITY-OF-S-ALE-,qw-
��'�� PUBLIC PROPERTY
DEPARTINIFINT
KI]mFaL6Y Deuvv
MAYOR 120 WA.W NGrON h`nl b 0 'yu.tK NASLACNl:Shl'R 01970
To-973-745-959S*F&v 976740-9W
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Aek Building: s6 C �c�;ydA
Property Address
5,� c Pig 4ei2
Property Is located in a;Conservation Area YIN Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: ,l
Address: n
Telephone: rj
3.0 COMPLETE THIS SECTION FOR WORK IN EX ST G BUILDINGS ONLY
Addition Existing
Renovation l/ Number of Stories Renovated
Change in Use a New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Hdef Description of Proposed Work: ' n`
-
- - --- Mail Permit to: -- Po 10� V, Cle l L' cs lwc�