15 COLBY ST - BUILDING PERMIT APP (002) OF'
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ROPERTY
F�IRTMEN'T
KU 0RILEVOR M ULL
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APPLICATION FOR THE tZPAi1Z_ >Qp*rOVA'TION CONDUCTION
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1.0 SIM INFORMATION
Laeadon Name &AcftFca vvc; C
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A"aly is bxabd in a;Coroavadon Arse YIN Hb ft DIM"YM
2.0 OWNER&W INFORMATION
11 Owner e1 Land
Name:
Addrssa:
/.s c0
TNephone: �7 b - 9 � — o l
3.000MPLEM THIS SECTION FOR WORK IN EXURZMG BUILDINGS ONLY
Addition Existing
Ranovatbn Number of Stories Renovated
Change In Use New
lDemoGdon Existing
Approximate year of Area per floor(af) Renovated
construction or renovation
of existing building New
Adel Descripdcn of Proposed Work:
7
- . -
Mail Permit to: - ----
11111►at is Ups CLUJ"Used the 0uildinp? 7—
M�ar{al d Buldirtp? W�e c` it dvreNkq.how marry -
Asbesbs?
VW 1M Buidr►0 Cormarm is law?
AtdAbatis Naera l
Address and Phorw
medulinwe Name
AddrNs and Phone HIC Rspfatr@Wr e
Cansfnrdion SL+Pervi'or'
Estlrnusd Cost PerrN FN Cala+la0on
Es*m tad Cost X=71111000 Rm*kmdd
Pemdt Fee= Eattinat�d Coat X S41/f1000 Ca�rnsrdaF-
An Addtlond SLoo is added as an
Afthisi diva dta Q&
Maly sun that an fields an PtOPsry and "aY twiaen to avoid delays In ProCessln0'
The wdwoWwd does Eby apply for s BuUdrq Permit to build to the above stated
specNlutfons. Signed under PWOft of POILO
Date
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