60 APPLETON ST - BPA-08-405 ROOFING EI'I'Y-OFLEn
PUBLIC P'S ROPERTY
DEPARTMENT
K.oeeZ.Wo.ea"
MAYM 130 Weswrw W*mar•
1b:tRe.7�9Ses.F�e7e.7geW
APPLICATION FOR THZ REPAIR RENOVATIM, C0r4W tRU(M0N
DE.rtiOLITION.OR CHANGZ OF USZ OR OCt MA_NCY FOR ANY EXISTING
STRUCTURZ OR BUILDING
�.o aln iNFORMAT1oN
Location Name SUROV
cc
Properly Is located in a:Cwwwvation Ams YIN Hkwft DbMd YM Al
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: GCe,) FeSS kr' _
Address
6c Apple to,\ Sy-.
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN E WMNQ BUILDINGS ONLY
Addition *Existing
Renovation roo¢ Number of Stori
Change In Use
Demolition
Approximate year of Area per floor (af) Renovated
COnrStruCti®n or renovation
of existing building psJ New
brief Description of Proposed Work:
str,p I bk/e.— V$ ASpkalt roofs? t replace w/
3(7 yr cc-rhr+e(.Y� cq I s h,�%y le
-- -- ---Mail Permit to: 1_Ua u L_ , o I Y 6 D - - -
I
What is ttw current use at the Building?
Bu. ? 4 �w If dlweiUng.how many unds?—L ----
atarial d riding
M vP5 '
will"BUD**Conform to Law? Asbestos?
-
Architsds Name —
Address and Photo I
MeehartWeNWM AAO'T L"'Je's E]Jli-n T�✓ �
Address and Phone If e C hdel VOL
Consbuction gulsrvmm Lkw"a HIC Registration 0
Estitnatad Cod- lof Pfo y�� Pem�t FM Calwlalfon
PermR Fee i FY(1 i Estlnwted Cod X i7/111000 Residandal
-- - - Estlmatsd Cod X$41/411000 Conwnwdal------- ---
An Additional$5.00 is added as an
Administradve charge. _
Make sun that all fields are property and legibly written to avoid delays in processing.
The undersigned doss hereby apply for a Building Permit to build to t,(w above stated
Signed under penalty of psrlurY X L2
Date
II i
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1 � 1
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9 0
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