2D SPRUANCE WAY - BUILDING INSPECTION --
�� PUBLIC PROPERTY
DEPARTbIF.1�1T
Ki.mwslzw oREuxL
yAYO` 120 WA"N=M$ W&K MAnACHMI-M 01970
114:MUMS"*FAX 97L74&98"
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDIlV
1.0 SITE INFORMATION
Location Name: iuilding: d
— - -
Property is located In a;Conmva*m Ares Y/N Historic Distrkt YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: 973 71-/5 lqq I-
3.0 COMPLETE THIS SECTION FOR WORK IN EXISXI its BUILDINGS ONLY
Addition $New
Renovation �/ Number of Stories
Change in Use
Demolition
Approximate year of Area per floor (sf)
construction or renovation
of existing building
Brief Description of Proposed Work:
--- - ---- -��� von� ��--- -- - ---- - - - --- -.
Mail Permit to: 1 P� oi1990 - -
What is the current use of the Building?
Material of Building? If dwelling.how many units?
Wilt the Building Conform to law? -
Asbestos?
Architect's Name 67
vn7U Pr�rEar��'-
Address and Phone Po o� 17 60
Mechanic's Name
Address and Phone
Construction Supervisors License 0 HIC Registration S
Estimated Cost of Projed$_Z�C> ✓ Permit Fee CalwWm
Permit Fee$ Estimated Cost X$71111000 Residential
Es*naW Cost X$1V$1000Commercial---- — --
- — 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
�Peermit;tob to the above stated
specifications. Signed under penalty of perjury
Date
N
two
IN
3
a