11 ROCKDALE AVE - BUILDING INSPECTION ov€fl BY TEE
t" T
7 13EWG GRANTED
IT`S OF S EM
Date O O�
Ward
I\ Zoning District
Ia,'pro orty Located In Location of (�
�%p Historic District? Yes_No t/ Building // l/( gz(-50—
' +;�ropptty Located in
i'066sirvallon Area? Yes No v
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Sid Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name
Address & Phone
Architect's Name
Address & Phone
Mechanics Name
Address & Phone 19761
What is the purpose of building? d.•-rY
Material of building?^ tiva*/� If a dwelling,for how many families?
Will buiiding conform to law?_ —Asbestos?
I$atlmated cost Oj City Ucense s J o' state Ucense 8
Hasa Improomnt
Lic. i 1bO/G
Si6nature of Applican
SIGNED UNDER THE PENALTY
'
!DESCRIPTION OF WORK TO BE DONE OFrPERdURY
.fir �ir�a ti�tros�aee-rv-.i-
MAIL PERMIT TO:
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