20 APPLEBY RD - BPA-07-873 3 REPLACEMENT WINDOWS `What is the current use of the Building?
Material of Building? If dwelling. how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone ( )
Mechanic's Name Pell
Address and Phone 45 52 K- , 0- � 1 I M�F 5 CS 3L
Constriction supervisors License# 084 83 Y HIC Registration# j L5-7-7�f
Estimated Cost of Project$ 253- - y. Permit Fee Calculation
Permit Fee$ O U 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 Pe o build to abov tated
specifications. Signed under penalty of perju
Date
of
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Cn*rOF SAMN -
PUBLIC PROPERTY i
DEPARTMENT
�i�me�u�r o�uwu
NAYC* 120 WAMINarM SMEU 1 c•'�HASSACKI;S01301970
`rm--978-745-9S9S 9 FAX 975-740.98"
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
F
SITE INFORMATION
ation Name: ; �a o, Building:
perly Address,20 " fP I"j .
property is located in a; Conservation' Area YIN Historic Dh&k t YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: —�G,�,w�cs � + '✓
Address: -ID 'trek c 4'y co.
SeSew. /,AA Llq-?6
Telephone: (-VOZ
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 (sj Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
-----------Mail Permit to: 15 P-6 d4 (Q. I ��,II n�} d+S32