1 BLOCK HOUSE SQ - BPA-2007-1080 GUTTERS What is the current use of the Suilding7
H dwelling,how many units?
t„taterlal d Buifdkq? pspestos?
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Architeds Name
Addre"and Phone
(tAechantt:s Name
Address and Phone
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Eslimated Cost d "� Pam'
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An AddMonal$6.00 in added as an
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Make sure that all tlelde am propedy and ebb written to avoid delays in proaealnp.
The undersigned does hereby appy for s 9uilding PwrrA to build to ttne abow stated
sem, Signed under penally Of PWW O
Date
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PUBLIC PROPERTY
DEPARTIN NT
111:1'�7�lS�!•Rye 17a.7�69W
APPLICATION FOR T)'S
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Ditmourm OR OWSz OIE usz OR OCCC� tvCY FOR ANY EXI_t'rnvG
1.0 SM INFORMATION
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PmWty Addnsc I T���CK e S�uarc S , ok 0 1 0170
P www is bread in a:CMIGNOW Area YM Hl"t titsMd YIN
9.1 OWNERSHIP INFORMATION
11 Owner of Land b4z U i a v f e e
warn. wa i l�a ✓ e a
Address: )Sf? goS�orl cSt/ee-
S oc e M-A 6 q 7
3.000MPLETE THIS SECTION FOR WORK IN EXWX=BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New.
Demolition Existing
Approximate you of Area per Roar(80 Renovated
construction or renovation
of existing building New
add Description of Proposed Wo
Cep`�e
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