0002 CEDAR STREET COURT - BUILDING PERMIT APP CITY-OF 1 -
PUBLIC PROPERTY
DEPARTMENT
KIMBERLEY DRISCOLL
MAYOR / � 120 WASMNGTnN SMELT•SMAIK MASSAQI{; I-M 01970
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0,/ 'R-L•978-74S•9S9S*FAIL:978-740-9346
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1A SITE INFORMATION
Location Name: �Q r r� rpg Building:
-- Property-Address. — {) —
Property is located in a; Conservation Area YM Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: �xrCkZ .._ (2�74 A (
Address: (
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing 3
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work: t
Mail Permit to:
J
What is the current use of the Building? �P-ci U1C9
Material of Building? 1, YLeC If dwelling, how many units?. �
Will the Building Conform to Law? Asbestos? G-
Architect's Name
Address and Phone
Mechanic's Name 1}
Address and Phone ILl 1� 2�
Construction Supervisors License# 0 HIC Registration#
Estimated Cost of Project$L� Permit Fee Calculation
Permit Fee $ 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
-ttoo build to the above stated
specifications. Signed under penalty of perjury
1
Date t
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