33 CIRCLE HILL RD - BUILDING PERMIT APP (003) What is the current use of the Building? �
Material of Building? If dwelling.how many units? c
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Win the Building Conform to Law? Asbestos? -
ArchitecCa Name
Address and Phone ( )
Mechanic's Name
Address and Phone
Constriction Supervisors License# HIC Registration#
Estimated Cost of Project i 0�• 6 Permit Fee Calculation
Permit Fee i y Estimated Cost X$71$1000 Residential
Ce - dill_ EstlmatedCoatX341/i100pCommerciai-=-------- _
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An Additional $5.00 Is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to7blh/s above ad
specifications. Signed under penalty of perjury
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PUBLIC PROPERTY
DEPARTINIF.NT
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MAYOR 120 WAMUN=W$'rMW•SNXKNEAMatLWYM01970
TM-978-74S-9S9S•FAm 978.740.9W
APPLICATION FOR TM REPAIR RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1A SITE INFORMATION
Location Name: -1/ Building:
Property Address:--3.3 e,,-k n'/�- - ------ - - --- - -- - -- — - -.
O14.7d
Property Is located in a:Conservation Area YM Hlet t District YIN iV
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: m ale
Address: Y -re le ///
, '41eM tgG - C)jg70
Telephone: 97J'- 7f/O- OVOS
3.0 COMPLETE THIS SECTION FOR WORK IN EXISnKG BUILDINGS ONLY
Addition Existing
Renovation ✓ Number of Stories Renovated d
Change in Use New 6
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Bdef Description of Proposed Work:
;Fe P/GC,',� 5ophef , 44✓►GI a
000- line.
Sa (,G1,
--- Mail Permit to: �per' T?_ r rL A l%pe
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