7 CLOVER ST - BUILDING PERMIT APP EITy-@Fr
PUBLIC PROPERTY
DEPARmmNT
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APPLICATION FOR THE REPAIR RENOVATION, CONSTRUCTION,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCPURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Z <a�>cJ Building:
Property Address --- - - - - -
Property Is located in a:Conservation Are@ YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land -Pt—
Name:
Address: G�6 U ei 5�
Telephone: 7
3.0 COMPLETE THIS SECTION FOR WORK IN EYISIING BUILDINGS ONLY
Addition t 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
Brief Description of Proposed Work:
Mall Permit to:
1
What is the current use of the Building?
Material of Building? N dwelling.how many units?-
Wit the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mechanics Name
Address and Phone HIC RegistratRegistration7
Construction Supervisors License 0ay
Estimated Cost ojed Perm Fee Calc uuiatbn
Permit Fee S Estimated Cost X$71$1000 Residential
EstUnated Cost X S11/S1oo0 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 dose hereby apply for a Building Perm build to the above stated
specifications. Signed under penalty of perjury X
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