9 BOARDMAN ST - BPA-2008-249 BATH REMODEL CITY-OF-
PUBLICPROPERTY
DEPARTbIENT
►iw*XLsr o.Mvv
UAYoa 120 WA MNcnM b MFEr
. ..... Wwttaan:settsOt970
147:9711443-9S95•FNC M740ASU
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY FMSTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property sw-- - -- — — -- — -- - - - - - - -
Property le located in a:Conservation Arse Y/N Ax�? Hlatorlo Dist I,2 Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Z
Address:
O �
Telephone: y
3.0 COMPLETE THIS SECTION FOR WORK IN Ma&U= BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Bref Description of Proposed Work:
-- - - -Mail Permit to: Cet/ S -
What is the current use of the Building?
0 if dwelling.how many units?
Material of Building? n a-
Will the Building Conform to Law? e
Asbestos?
Architect's Name
Address and Phone l )
Mechanic's Name
Address and Phone
Construction Supervisors License S ����� HIC Registration 0
Estimated Cost of Project S COOO• Paumlt Fee Calculation
Permit Fee S Estimated Cost X$71311000 Residential
Estimated Cost X$Ijj$l000 Commercial
-_-----
An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build
to�lthe above stated
specifications. Signed under penalty of perjury X vl !
Date
Y �
O D 9 Y
' .
4