16 BAY VIEW CIR - BPA-2007-6327 HANDICAP RAMP EITY-OF SAL
PUBLIC PROPERTY
DEPARTMENT
KIMBE.RLEY DRISCOU.
MAYOR ?V WASHIN(TON S'IRFEr•SAI.W%%WMC UShXTS 01970
-ML—978-745-9595♦FAx:978-740.9846
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION"
>� f3a P Building: o
Location Name: —
Property Address:
Property is located in a; Conservation Area Y/N Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land l
Name: �v
L ^ 7
Address: // D
�l9 l��yl�/P4t Cll✓r/!P -
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 Pr posedWork: L � �
P�'Or✓rd r y /% m rd r,:) xPF .
Mail Permit to: e r! Y/ ,
r What is the current use of the Building?
Material of Building? GtA5�a t,— If dwelling, how many units?
Will the Building Conform to Law? p 5 Asbestos? D
Architect's Name /L tf -
Address and Phone l )
Mechanic's Name _ —
Address and Phone r S
Construction Supervisors Licensee r# C9 7�.� HIC Registration# 1Q3e!2G
Estimated Cost of Project$—j - Permit Fee Calculation
PennR Fee$— Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$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 Permit ild to the ab v t
specifications. Signed under penalty of perjury /�
Date / a 0
9�
N
v N ,
a
L � �
%2. J
s.
aV u a