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23 BUENA VISTA AVE - BPA-06-1074 .� CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KIMBERL.EY DRISCOLL MAYOR AY Q� 1?0 WASHINGI'ON STREET 1 SAIEM,NASSACHCSEITS 01970 IdJ TEL-978-745-9595 #FAX:978-740-99" 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: n , Property is located in a; Conservation Area Y/N IVP Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land [Telephone: me: uN t/�/✓. 1/ dress: (J t✓G e, B (�) 5 -4 /7 ✓�— /�le� /n 09 114- 9/ *) - 4 10 - (00 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation X Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building I New Brief Description of Proposed Work: (�0-Aj/# G ,!t Mail Permit to: 2 3 °2U647 ,4 V/ Sl�9 4(_ What is the current use of the Building? Material of Building? /^� If dwelling, how many units? O h e- Will the Building Conform to Law? er Asbestos? Architect's Name Address and Phone /� ( ) Mechanic's Name l°� L`J LIL14 l Address and Phone? G� ih�r� t' �d 9 Ys- Z74r'0 Construction Supervisors License# ©G Z2 3 C� HIC Registration# Estimated Cost of Project$ �flO "' Permit Fee Calculation Permit Fee $ f 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 Building Permit to build to the above stated specifications. Signed under penalty of perjury X a O N a+ L OMM Q a E•r � o C�� d ` �.n L a CL i