3A RUSSELL DR - BUILDING INSPECTION CI`Iy-OF S ENWP !
PUBLIC PROPERTY
DEPARTMENT
KI%WFJUEYDRJSWLL 7
MAYOR O1 120WwilNC.TMh''rn 0&M.E MA1SAC L5L1-M01970
TEL-978-74S-9S9S*FAu:97&740.9846
CONSTRUCTION
TION FOR THE RE
PAIR,
RENOVATION,
APPLICATION
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: 15�r G/ Building:
PropeAy Address: �`f r45Se l(
propwty is Located in a; Conservatbn Area Y/N A) Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: G
Address: K cU'
Telephone: 979` 3�3S d ZI?
3.0 COMPLETE THIS SECTION FOR WORK IN FYiCTiNC 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 New
of existing building
Brief Description of Proposed Work:
�2sAA 11-11e-.
w
Mail Permit to: 70
What is the current use of the Building? y
Material of Building? if dwelling.how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone-Zi
Mechanic's Namep T /
Address and Phone /%' d da�
Construction Supervisors License# HIC Registration#
Estimated Cost of roject$ (DO, 15�O Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$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 thS above stated
specifications. Signed under penalty of perjury X
Date
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