5D STILLWELL DR - BUILDING INSPECTION PUBLIC PROPERTY
DEPARTMENT
I:I�MFAIY URIS/iUlL
S(AvoR 1211 WALi1Nc,-mN SlREtT'♦SAI}si.%LAtSAwt:Stmrs 01970
/ TEL 979-745-959S•FAx 978-740-9846
APPLICATION FOR THE.REPAIX REN OX CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE O.R BUILDING
1.0 SITE INFORMATION
Location Name: c I_ M ,v !'R2�� Building: _
Property Address:
Properly is located in a;Conservation Area Y/N w Historic District Y/N.
2.0 OWNERSHIP INFORMATION
..... -.... .
2.1 Owner of Land -
Address:
S`P 5� ) lcuet / O ,e
Telephone:. _ 'Y 7 " 7 4q 7aet( -
3.0 COMPLETE THIS SECTION FOR WORK IN BUILI3INGS ONLY
Addition PEiisb"nong
Renovation Number of Stories vated
Change in Use _ New
Demolition
Approximate year Of Area per floor(sf) Renovated
construction or renovation
of existing building New
Briaf Description of Proposed Work:
tfe^,Que- Pi;or3./cl . t i�J -�'M2 i(2e(JIFiL2 whe2,e i7 �1A5
S*�r}; i'0w'! Eli `✓
--1lJIIICV.v.---------- ._..
Mail Permit to [A 01%0 _ ---
978-977-9900
What is the current use of the Building? -
Material of Building? if dwelling,how many units?_________—
Wili the Building Conform to Law?' e r -- Asbestos?
Architect's Name
Address and Phone Peabody MA 01%0 ( )
Mechanic's Name --
978-977-9900
Address and Phone -
Construction Supervisors license# HIC Registration#
Estimated Cost of Project$ /5/O � Permit Fee Cakarlatiom
Permit Fee$ �� Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional$500 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 pedury �TT
�/ --
Q9t@ /2 IFS Q
01 N
y
00
o
u � e
Zj
G
I � -