25 BENGAL LN - BPA-2008-346 REPLACE 2 WINDOWS G�TU1�5a�.Eti
PUBLIC PROPERTY
DEPARTMENT
[1YRfY.
NAVOe UVWAiWM47[fM'317ii!• �IASiAW:SYTR 01970
11L•9. 743-9sy•PAZ M74MO
APPLICATION FOR TUX REPAIR. RENOVwTrnN_ F`nrreTonr*ION .
DEMOLITION. OR CHANGE OF USE OR 990MANCV_ FOR ANY Ui 2911MU
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
— Prop"Addresa:-
v2 .� 2n
Property Is kxxded In a.Caraervation At"YIN Historic DbMat YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address:
�Me
Telephone.
3.0 COMPLETE THIS SECTION FOR WORK IN 87tlS?'Nia BUILDINGS ONLY
Addition Existing ✓
Renovation Number of Stories Renovated
r
ange in Use Newmelidan Existingproximate year of Area per floor (sf) Renovatedstruction or renovation
of existing building New
anal Description of Proposed Work:
t�ep �ace o2 �rnG1or�S
- - Mail Permit to: 3 q S ��r�/r�r� A v��v r GZ (0 0 -7
I
What is tia current use of the Building? — it dwelling.how many units?
Material of Building?
Witt the Building Conform to law? 2 Asbestos? .
Archibcrs Ns" ( 1
Address and Phone
Meehanir.'s Name olJa f
Address and Phone 7 ��9 `� 10
constfon guperviaors licartw s< HIC
� Registration B
Estimated Cod of —U PermN Fee Cala�htlon
Permit Fes i__
Estimated Cod X i71$1000 Residential
Estited Cod X i1 vi1o00 Camnercia4
ma
An Additional $5.00 is added as an
Administrative charge•
Make sure that all fields are properly and lagiblY written to avoid delays In processing.
The undersigned do"hereby apply for a Building Permit to build to the above stated
spadftationa. Signed under penalty of pWJurY
Date
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