9 CURTIS ST - BUILDING PERMIT APP CrrrorS NI
-
PUBLIC PROPERTY
�. / DEPARTMENT
Mwraa 130 WAn*r4r cw SnEcr SLHK\Gtu04a:strR01970
-M 978••74S.9"S•FAM 97M-740- M"
LIGATION FOR THE REPAIR. RENOVATION, CONSTRUCTION,
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUH.DING
1A SITE INFORMATION r
Location Name: Building:
Property Address:- --- _—
Property is iocated in a:Conservation Area Y/N_QGH1stoft District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land �{ _
Name: /
Address: /
Telephone: 6 —
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
6dd Description of Proposed Work:
-- --- ---Mail Permit to: 7TA i
What is the current use of the Building?
Material of Building? If dwelling. how many units?
WiU the Building Conform to Law? Asbestos? -
Architecrs Name
Address and phone ,c
Mechanic's Name
61
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Address and Phone
6 G
t;,onstructionSuparr isors License
071 6 17 HIC Registration -
Estimated Cost of Project /
�jp. Permit Fee CWW
S�— alai
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated CostX i11/$jooO Comrnerciat------_._An Additional $5.00 Is added as an
Administrative charge..
Make sure that all fields are property and legibly written to avoid delays In processing.
it ,
The undersigned does hereby apply for a Building Permit to build to the a v
specifications. Signed under penalty of perjury
X
� Date
06
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