5C STILLWELL DR - BUILDING INSPECTION (2) Er OF AXLE
PUBLIC PROPERTY
DEPARTMENT
KI%filau"DRMOLL
MAYOR -120 W WING YIN S•TREEr•"LEK SS,IMAC ust-rm 01970
TO--97&745-9S9S#FAX 978-740.9846
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: ,j- G r, Building: %i C.fC/'r.0.�. A/C
Property Address: s_ S �y//w�!/ �/n -5a-k - 1qc, or 9 7 v
Property is located in a; Conservation Area YIN -j Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address: [ —G S f/
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation ✓ Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation New
of existing building
Sri& Description of Proposed Work:
�✓/x. ,� �� Cojo J �.. Coves, �,•� �//-�,
Mail Permit to: 010 o 812,-V el-07/ Z-e2a
What is the current use of the Building? C r
Material of Building? If dwelling,how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone 00-*-�, C5 do?�/ s� � /"LQ. Old d c77 19
Construction Supervisors License# HIC Registration#
Estimated Costpf PGr�oject$ /��d, � Permit Fee Calculation
Permit Fee ---. Estimated Cost X$7/$1000 Residential
Estimated Cost X$111$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
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