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2 WITCH HILL RD - BPA ' PUBLIC PROPERTY DEPARTMENT I:1%01ERI.EYORISI:UUr �� MAYOR O 1?0 WASHINGfON$IREEI 0$ALF111 \(A1UC311;5h1'1501970 1Ei 978-745-9595* 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: yNTHUA1y C'F/21ST?NA Oe)V Building: Property Address: , wmo-o N1u- P-D Property is located in a; Conservation Area YIN Historic District YIN 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: fiti—iHONV $ Cy2/STIAIA CO)/ Address: o) W 17Z' H H 1 C.-L TZ D . _ SA L�H �414 019-7-0 Telephone: G'j 8 - 6& - 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 Brief Description of Proposed Work: NTo �`�C�SnNU �PC�Tl1N6 . - Mail Permit to: k R 2 What is the current use of the Building? ¢ Material of.Building?, if dwelling,how many units? / Will the Building Conform to Law? AsbestosT /1/PJ' Architect's Name Address and Phone l ) Mechanic's'Name" L9.P2© % Ii _ 'Jc* ` Address and Phone Construction Supervisors Licerse ItRegistration kw Estimated Cost of r ct Permit Fee Calculation Permit Fee Estimated Cost X$7/$1000 Residential Estimated Cost X:$11/$1000 Commercial An Additional$4.00 is added as an Administrative charge. Make sure that all fields are properly and legibly Written toavoid delays in processing. The undersigned does hereby apply for a Building permit to build to the above stated specifications. Signed under penalty of per/uryy /� s Date ti e �I N 1 Y \ t N 1� 0 z\ u