15 BERTUCCIO AVE - BPA-2007-183 WINDOWS, KITCHEN, ETC M 4 g PUBLIC PROPERTY
C lC=t/S�S3 DEPARTMENT
KIM 11FALEY DRISCOLL / "
MAYOR G ? M WASHIN 978-74.59 0 S, LLK VA-7409LLSL 3 01970
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: IS 6ErcTa�cc(v Wv�
Property is located in a; Conservation Area Y/N r4 Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land CAh1`LavfL, a awl r
Name: �� VVACCA. tcw> c
Address:
l MAta-16oR-oVtjZd1 V+tTKA-v,% �Msr
Telephone: trl"1 _ so% .S�s(.Z
3.0 COMPLETE THIS SECTION FOR WORK IN FYICTLkG BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated E,
Change in Use New d
Demolition Existing 9&0
Approximate year of Area per floor (sf) Renovated (gyp
construction or renovation a6Ol.0
of existing building New
Brief Description of Proposed Work:
// WI'n.�ws 71a rre/o/"c./
rz�./ate L,'fre� ea�lolt�,z'fs' � '�%t �/vDv
Mail Permit to: Oh r - - _ - _--- --
% �
What is the current use of the Building? 05
Material of Building? cJirDA( 4,e J6iL If dwelling, how many units?
Will the Building Conform to Law?_
g Asbestos? ILA"
Architect's Name J
Address and Phone t j
Mechanic's Name
Address and Phone
Construction Supervisors License# R3(a0 8 HIC Registration#
Estimated Cost of Project$ ��� Permit Fee Calculation
Permit Fee$ Estimated Cost X$71$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 to
build
to the above stated
specifications. Signed under penalty of perjury
Date
00
a
N
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