9 BELLEAU RD - BPA-2008-612 PELLET STOVE What is the current use of the Building?
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Material of Building? u �� If dwelling.how many units?
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U tlro Building Conform to Law? Asbestos?
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Architeds Name
Address and e ()
Mechanlds
Address and Phone
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Construction Supervisors ucqnse HIC Registration if / 3 y 3 9 5
Estimated Coat of Project i J Permit Fee Calculation
'� Estimated Cost X$7/$1000 Residential
Permit Fee i
Estimated Cost X S41/: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 Bui ' ng it build to the above stated
speciificcations. Signed under penalty of erjury /�
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PUBLIC PROPERTY
DEPARTMENT /�-
K{\NCM,,IIL-V- DIY l
IMAIW yA'GSAOi1;5l7-TS Ot970
'[tors rt-715-9M•FArc M746.9M
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION,
DEMOLITION,OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUII.DING
1.0 WM INFORMATION
Location Name: 1e Building:
Property Is located in a:Conswvatlon Ares Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: ,I -p
Address:
Telephone: 7 t1 �r--
3.0 COMPLETE THIS SECTION FOR WORK IN EYIS11MIG 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
Sdef Description of Proposed Work:
Mail Permit to: __ d t �✓ - -