2 AUBURN RD - BPA-08-183 ROOF --
PUBLIC PROPERTY
DEPARTMENT
%IAA a 130WA9UrAGWWhMEKr0S LLKNA\MCKL LM01970
TEL-971-74S-9S95•FAS 97/-740.96N
APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION.
DEMOLITION,OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
IA SITE INFORMATION
Location Name: Building:
(,13 u
Property is located in a;Conservation Area YIN District YIN
2.0 OWNERSHIP INFORMATION
2.i Owner of Land
Name:
Address:
Telephone:
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 (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
---- - ---Mail Permit to: Mtr 00 i woe) /��
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 G l ( )
Mechanies Name
Address and phone J rn
ConsUurifon Supervisors License#
671 6 17 HIC Registration#
Estimated�s ;?aGo Permit Fee Calcubdion
Permit Fee Estimated Coat X$7/111000 Residential
__- . . --- --- Estimated Cost $11/411000 Comrnwciat
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 Permit to build to the a v s
specifications. Signed under penalty of perjury X
Date
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