9 CLIFTON AVE - BUILDING PERMIT APP (002) � esrdep�
What is t current use of the 8uildin�4
W he tf dwelling,hoW many units?--�—
Material of Building? W Asbestos?
Wig tM Building Conform to Law?
Architeds Name ( )
Address and Phone
Mectwmies Name r"s J?Yi �� �G1 rhar� Gl
Address 7 z lion il =
Construction��License 0 D 7 33 7 S HIC ROW
Cost, Proted i D L. Fee Calculation
Estirt+ated
� J'�� Estimated Cost X$71$1000 Residential
Permit Fee i� Es*natsd Cost X$"/$1000 Commercid--—
An Additional $s.00 is added as an
Administrative
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned doss hereby apply for a Building Permit to build to the above stated
e
speciflcati". Signed under penalty of Perlury
Date
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GITY_OFS --
PUBLIC PROPERTY
DEPART14 &NT
I�I.mFJL6Y ousrau —
MAYOR
13o Wwur c n,N 'MM•S,ut4,yAMAQ4 SkWM ot970
APPLICATION FOR THE REPAIR RENOVw�rr N CON TRUCTION
O
DEMOLITION R CHANGE OF USE OR f�lpArirCY FOR ANY EXIS a
STRUCTURR OR B&H&M
1.0 SITE INFORMATION
Location Name: r1 ich vlojruiv,4�� Building:
Rmperty Is bcated in a;Conservation Arse Y/N Hkftft Dlatrbt YM
T
P INFORMATION
nd
3.0 COMPLETE THIS SECTION FOR WORK IN EYIS.LNp BUILDINGS ONLY
Addition Existing
Renovation
Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
9oef Description of Proposed Work:
Mail Permit to: � T�n - - -
Plb�
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24"
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� 218424R
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24"
12" 24" .! —3� {, 33d--$jo
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/ g h€'" This is an original desist and must not be DesigrtW:5/16l2
All dimensions sin deli ons given ere %v released or copied unless applicable fee Printed:5/16/200
subject to verificatiwt on Job site and rec x o�ours has been paid or job order placed•
adjustment to fit job conditions.