6 BENTLEY ST - BPA-2008-127 ROOF ' PUBLIC PROPERTY
DEPARTMENT
KINWRLEY DRJSCOLL
MAYOR 120 WASHINGCON S7RFEr♦SALEN•.AtAS&ACHLSLIM 01970
TEL•978-7SS-959S*FAX:97&740-98"
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE_OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address:
(Q Qer-A l2 SA Saaem (YlA Q iG10
Property is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Cher 1
Address: 9 \
MOlc1 r�t'_C S Lam � Ma�cb�a�\tie.a.a„ i f3lA 0\q y 5
Telephone: '7%1 GSt 3652
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 (so Renovated
construction or renovation %ciao New
of existing building
Brief Description of Proposed Work:
�Pp�� mew 060 cvbbec 1•0aF systems, Ca rth� � %�e fl�� coa�<
Mail Permit to: Ulm
What is the current use of the Building? f@St P3�fi\c� 1
Material of Building? If dwelling, how many units? 3
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mechanic's Name Cslenrl
Address and Phone P Ci Rex-tE"t f3s�o Flu n\A o1g1 t Q q L—I S�
Construction Supervisors License#IS CO2123 HIC Registration# 104 �S2
Estimated Cost of Project$\b;Z SO Permit Fee Calculation
Permit Fee $ $D.1S 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 BuildingPerm/it to build to the above stated
specifications. Signed under penalty of perjury X �
Date
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N
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