0010 CELESTIAL WAY - BPA-08-144 What is the current use of the Building? If dwelling.how many units?
Material of BuildhV? Asbestos?
Wig the Building Conform to Law?
Amhlteds Name
Address and Phone
Mechanic's Name Se-0-f�-I S
\ MA- eLy3z �7Y- z�S7zSS
Address and
t,onatruction Supervisors Ucon
se HIC Registration$ 1±2
Estimated Cost of Project$ 300o puma Fee C"Isdon
m
tg Fee i U Estimated
Permi Cost X$7/111000sid
1000 Reential
Estimated Cost X Si 1/$1000 CommercW---- - -
- An Additional$6.00 is added as an
Administrative charge.
Male sure that all fields are properly and legibly written to avoid delays In processing.
The undersigned does hereby apply for a Building Penn uild to b e state
specifloatlons. Signed under penalty of Periu
Date
06
1
I PUBLIC PROPERTY
(� DEPAR
TbiE►�1T
�twroa
130 WASUNG W MOW•$AUiK.M&qLAG&Sk-j-M 01970
TXL-M715-95"•PAZ"&j4&"0
AAPk ICATION FOR THE REPAIR RENQUILQN, CONSTRUCTION
DEMOLITION, OR CHANCE OF USE OR OC X&M FOR ANY EXISTING
STRUCI1rn� OR BUIL Dl�tr
1.0 SITE INFORMATION
Location Name: Building:
Address
lc7
Property is bcated in a:Conservation Area YM Hlstarlo DWwd YM
2.0 OWNERSHIP INFORMATION
4.1 Owner of Land
Name: �c��—i 5 -J v}"F�c
Address 1c) �e�e571 c
Sal Nr,4 c3�4-7 0
Telephone: 7 _ S5-2-7
3.0 COMPLETE THIS SECTION FOR WORK IN 81.1I1.10ING3 ONLY
Addition Existing
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
add Description of Proposed Work:
-- - --- Mail Permit to: (PeL C� CyJ�u s Y5 �d (nJ 'U 83z