1A SPRUANCE WAY - BUILDING INSPECTION (2) - CITY-OF$ALEX _ ..
PUBLIC PROPERTY
DEPARTMENT
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N.Maa taow.vurw�ni sitar
Su&K wAssMan:se„s 01970
To-.97a.745-9MS•PAZ W&740,%M
APPLICATION FOR THE REPAIR. 1tENOVA7'IONa CONSTRUCTION
DEMOLITION- OR CHANGE OF USE OR OCCUPANCY FOR ANY WSTIN
STRUC � OR BUR DVI
1.0 SITE INFORMATION
Location Name:Property I3WkItn¢
-..__ ..
Address:_
PropartY b boated In a; Conservation Area Y/N Historic Dhtrlat Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: q-7-) g co
3.0 COMPLETE THIS SECTION FOR WORK IN MusmlNp BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use a New
[Appfroximate
Existing
r of Area per floor (sf) Renovated
enovation
ng New
BdetpDescription of Proposed Work:
pares
-- - — P:O.-Box 4074--- - - —
Mail Permit to. Peabody,MA UIVOU _
What is the current use of the Building? If dwelling,haw many units?---
Material of Building? Asbestos?
"it the Building Conform 10 L"T
Archited's Name Peabody,MA 01960 ( )
Address and Phone -
Mechanies Name
Address and Phone HIC Registration 0
Conebvction Supervisors License>t
FaOnmated Cost of project S ���� Pemnil Fee Calculatlon
f�— Estimated Cost X$71:1000 Residential
Permit Fee
Elated Cost X$I I/:1000 Commercial --
- — -- An Additional $5.00 is added as an
Administrable charge.
Make sure that all fields are properly and legibly written to avoid delays In processing.
The undwslgned does hereby apply for a Buikling permit to build to the above stated
specifications. Signed under penalty of perjury
Date ..�6� " 7
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