18 BEACH AVE - BPA-2008-759 REMODEL 1ST FL BATH --
PUBLIC PROPERTY
DEPARTIMEINT
Kuowatsr DILUA) L
MAYOR 120 WtiswrwrON S'M= '�Attx MAssAal3kllS 01970
TEL 976745-95" ♦FAx 97L740-96M
APPLICATION FOR THE REPAIR RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Locatlon Name: Building:
Property Address: $ ead7 r
Property Is kcatted in a; Conservatlon Area YIN Historic Dkdrlat YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: 14 1 C-4,1h E
Address:
0"'/q76
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTrNA BUILDINGS ONLY
Addition Existing
Renovation ✓ Number of Stories Renovated
Change in Use New
Demolition Existing fa Sl
Approximate year of 6 $ Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Pro sed Work:
(Z�rn oc�el f� rs�.�/ter 6 a.�h��d��n aP� j r/ •I.���Mail Permit Permit to:
What is the Current use of th/g Building? /�Q5 l��/✓ Q� /
Material of Building? t r�oGf ✓ If dwelling, how many units?
Will the Building Conform to Law? `I 2S Asbestos? 4
Architect's Name
Address and Phone
Mechanic's Name a4OLL A04 -T L
Address and Phone
s/--y r
Constriction Supervisors License 0 O S54124) HIC Registration p o3�7
Estimated Cost of Project i 0 00 Permit Fee Calculation
Permit Fee i Estimated Cost X$7/$1000 Residential
Estimated Cost X$111$1000 Commercial
An Additional $5.00 is added as an
Administrable 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 above stated
specifications. Signed under penalty of perjury
Date-1=�- ,3=a
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