7 WITCHCRAFT RD - BPA (002) PUBLIC PROPERTY
DEPARTMENT
KI\RIFJLLEY DRL;CULL / (/
O
MAYOR �"// 120 WASHINaroN$1HEHr•S=5,�1AAACHl: -M 01970
���YYY"' TEL 979-7359595 4 F=979-740-93"
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
I A SITE INFORMATION
Location Name: Building:
Property Address:
Property is located in a:Conservation Area YM Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: r✓� S
Address: 7—
Telephone: Li S 22-9 0 - - 1 5- L/ r)
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation ✓ Number of Stories Renovated
Change in Use 2 New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation f 4)6 g
of existing building New
Brief Description of Proposed Work: I I L
u (`eno Is.4 �j : .� OU- Pal}� 7s
Mail Permit to:
What is the current use of the Building?
Material of Building? Gvo- J- If dwelling, how many units?
Will the Building Conform to Law? PS Asbestos?
Architect's Name
Address and Phone t
Mechanic's Name j
Address and Phone 7 �✓� 7G tic�»� i S /ems
Construction Supervisor License# e06 3 r/ HIC Registration#
Estimated Cost of Project Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional$5.00 is added as an
Administrative charge.
delays in processing.
Make sure that all fields are properly and legibly written to avoid ys p g
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of perjuryy� �
0
N
w
8 7
a
� � y
�t o - o
a
u
a a�5 a