4B ARNOLD DR - BPA-2007-596 REPLACE ADAPTOR CAP EI` Y-OF -AL -
PUBLIC PROPERTY
DEPARTIVI&NT
�:i�mF.wsrotusc:ou ,%�(/]l��/f/ //�� j/�/
MAYOR �j/ ✓ 6 lJ / 120 WASMNOToN smEEr,� 'S=s,�1,�5,�ctiLst�-rs 01970
141978.745.959S FAx:97&74o.9U6
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: 19Building:
- -- Property Address G1_- 6 6, 412_00/6 0 Z
Property is located in a; Conservation Area YM (/ Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address: Y_ 3 A 2�O l ^�
Telephone: G /8J_
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 (sn Renovated
construction or renovation
of existing building New
grief Description of Proposed Work:
The Chimney Guys
-P.O. ox — — -- -- ----
-- PeatP060 -
Mail Permit to: 979_977-9900
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 The Chimney Guysex
Address and Phone
Mechanic's Name 978 977 9900
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost Pro $ ` Permit Fee Calculation
Permit Fee Estimated Cost X$7/$1000 Residential
---- — ---- — — — Estimated-Cost-X 51-14-1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that ail 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 X
I
00
V
x
a G7 `o
a� -
.«,'ti ';"i' �S