12 BROAD ST - BPA-07-1066 What is the current use of the Building? units?_/
Material of Building? "" )6 G� If dwelling,how many
"Ithe BuddingConform to Lava? Asbestos?
i
Architect's Nam• /
Addreu and Phone /
Medhanjes Name
Address and Phone �. la o 7 y d
Construd�Supervisors Litsnas CS ti 3 i7/ HiC Registration
Estimated Cost �jed Permit Fee Caleulatlon
Permit Fee Estimated Cost X$71$1000 Residential
- Estimated Cost X:111f1000C nwfwci d
An Additional$5.00 is added as an
Administrative dwgs.
Make sure that all fields are properly and legibly written to avoid delays In processing.
The undersigned does hereby apply for a Building permit tobuild to the abov ted
specifications. Signed under penalty of perjury
Date ?
i
N
s
Ly �
S
L
— P� L
i
t
EIT-OFS �
PUBLIC PROPERTY
DEPARTINONNT
134wwwWcx+a`nEsr 0may.. MAC :UM01970
Tfi 9. 7i3.9S"•PAZ M740.""
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
CC��ANC
DEMOLITION. OR CHANGE OF USE R OY FOR ANY EXISTING
STRUCTURE OR BUILDIN %
1.0 SITE INFORMATION
LocatIon Name: Building:
ew - - - -
1 J rU t 5�—
Property Is located in a:Cormnadon Area YIN Hlstwt OWuld YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: 4
Address:
Telephone: 7,r 7 p
3.0 COMPLETE THIS SECTION FOR WORK IN "'AXING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sn Renovated
construction or renovation
Of existing building New
91lef Description of Proposed Work:
1,-1 Aj C o,v Nr��; hour
Mail Permit to: //3
lI