52 CHARTER ST - BUILDING INSPECTION (3) EITX-OFSXLEIC _._.
��'� �S �d �S° PUBLIC PROPERTY
. DEP�R'I i�IF.►�tT
X1%01E2LZVORLS AX.L
MAYOR
130 WA1MNG M SST•1hL&K MAMAO1lShllS 01970
710.M745AS"•FAX 979-744984
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 Is bested in a;Consmadon Area Y/N Historic D IN
2.0 OWNERSHIP INFORMATION
2.10wnerofLand • te,
Name:
Address: a CAS
s4(ew� tiL�t 77?
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING 13UILDINGS ONLY
Addition Existing K
Renovation / Number of Stories Renovated
Change in Use 3 New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
Relu,J l rc�
-- - — ----Mail Permit to:
What is the current use of the Building?
RPS
Material of Building? IE//tG E-- if dwelling.how many units?�/
C S
"a the Building Con to Law? Asbestos?Gr
pvchited's Name C�L S
Address and Phone ( j
Mechanies Name
Address and Phone
y f(a�kci s� �9/ta ceczei
ConsltucUon supervi
sors License 0 D666 / HIC Registration fi
Estimated Cost of Project Permit Fee CalcuMm
Permit Fee S 6 Estimated Cost X$741000 Residential
Elated Cost X S111S1000 C4mmercia4------
- - 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 aPPN for a Building Permit to build to the stated
specifications. Signed under penalty of perjury X 6%/—O
Date 3 0
0
-41
N
a,
o � O
y 3
96 . o. - -
1