0008 BARSTOW STREET - BPA-08-53 EITY-OFgXLEb _ -
PUBLIC
PROPERTY
DEPARTMENT
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VAYaa 130 WASHINGRw bft=•SAWK WAaAuuserM 01970
7f7.:M745-9M•PAx:M7404M0
APPLICATION FOR THE REPAIR RENOVATION, CONSTRUCTION,
MMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
�penr 3 ,Z -�-m
Property is located in a:Consarvatlon Ares YIN Historic DisMct YIN �w
2.0 OWNERSHIP INFORMATION
9.1 Owner of Land ; .
Name: 1
Address:
Telephone:
3.000MPLETE THIS SECTION FOR WORK IN EXULUM 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
Sdd Description of Proposed Work:
Mail Permit to: 444 /G ,� pti-, ,
What is the current use of the Building?
� r� H dwelling,how many units?
Material of Building?_---Iw'—n—,, �
Wily the Building Conform to Law? Asbestos?
Archftds Name
Address and Phony ( 1
Mechanic's Name
Address and Phone l G ,6c IZ, Q^"y �Q�i 9 7k - 7
Construction Supervisore License sa HIC Registration 0 /d 0 /6 7
Estimated00. 0 e Pam*Fee Calculation
Penns FN S Estimated Cost X$7/$1000 Residential
Estimated Cost Xill/:1000Cmnmsmlai-=
An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build too the above stated
X
specifications. Signed under penalty of perJury -L °
Date 7 S 0
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