0155 WASHINGTON STREET - BPA-08-2028-34 CENTRAL HOUSE - — ErrrOFSXLENr— --
APUBLIC PROPERTY
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O oo APPLICUA\TION FOR THE REPA RENOVATION, CONSTRUCTION.
D'E'MOLITION, OR CEWNGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1A SITE INFORMATION Q mO
Location Name: C ova_ Building:
property Addresr. JcS' kl)R
Property is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address: e—( e> C C9 Lz_ z�N
Telephone: G 2 5"
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing Z
Renovation Number of Stories Renovated
Change in Use t/ New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation I I SSo New
of existing building
Bdef Description of Proposed Work:
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Mail Permit to: pG��Z " Fcy? -Fj>e.k L 17
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What is the cuff ant use,of th1e Building?
Material of Building? -ti'YM2� � If dwelling, how many units? "l
Will the Building Conform to Law? Asbestos? s7 r)
Architect's Name !A),
Address and Phone
Mechanic's Name ra Sw
7 "yes s
Address and Phone
Construction Supervisors License 0 Ca226i'J 3 HIC Registration N
Estimated Cost of Project$ j7 3 o oo Permit Fee Calculation
Permit Fee 5 -P U OLD Estimated Cost X$71$1000 Residential
Estimated Cost X$71/$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
Date
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