9 CLEVELAND RD - BUILDING INSPECTION EIT` g
PUBLIC PR'6' OPERTY
DEPARTb1tE,�iT
KIND
H.roa 130 WA$MNG M SnI=•
may.NatseUHlstl'is 01970
TEL 97&74S-9S95.FAX M740.966
APPLICATION FOR THE REPAIR,RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR FOR ANY EXISTING
STRUCTURE OR BUILD]IN
1.0 SITE INFORMATION
Location Name: SuikUng:
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Properly Is located in a;CwuwvaWn Area YM Historic District YM NJ
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land 6I\OS Zi�r��� �3irYlt7t�Y�iS
Name:
Address:
Telephone: CM? 1q �
3.00OMPLETE THIS SECTION FOR WORK IN EY49I1NG BUILDINGS ONLY
Addition ng
Renovation =J;
vated
Change in Use Demolition xisting
Approximate year of Area per floor(sf) Renovated
construction or renovation
of existing building 0 New
Brief Description of Proposed Work:
wok
--Mail Permit to: E f✓ Qan - - -
What is the current use �usa of the Building?
Material of Building? If dwelling,how many units
T
Witl the Building Conform to Law?
Asbestos?
Archited's Name
Address and Phone ( )
Mechanic's Name.
Address and Phone
Construction Supervisors License# - HIC Registration N
Estimated Cost of Project S%Oo�i arI Par"Fee Cak ulatlon
Permit Fee i-O�r y D Estimated Cost X$7/51000 Residential
- Estimated Cost X 1111/$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 bu W the �b�o rasta ed
specifications. Signed under penalty of perjury Date
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