6 DEARBORN ST - BUILDING PERMIT APP (002) E`Q-77IT7tOF
PUBLIC PROPERTY
DEPARTNIEI�TT
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APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
-
6
Property Is located In a;Conservation Area Y/N HWWric DbMd YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land J%44✓!E"G r., L
Name:
Address: 6 D��P,B�'�?!✓ S� �fr�L.�i�-t � l g 7 0
Telephone: — 7
3.0 COMPLETE THIS SECTION FOR WORK IN EXISMIG, BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of L
rea per floor (sf) Renovated
construction or renovation
of existing building New
Bdet Description of Proposed Work:
Mail Permit to: ja4C,*1 Ai5� 70 - -
I — —
What is the current use of the Building?
Material of Building? LA, Z_ It dwelling,how many units?
21
Will the Building Conform to Law? �"e S Asbestos?
Architect's Name
Address and Phone ( 1
Mechanic's Name
Address and Phone
Construction Supervisors License i/_��HIC Registration fi
Estimated f Projects d >" Permit Fee Calculation
Permit Fes Estimated Cost X$7/s1000 Residential
Estimated Cost X stt/s1000 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 build to the above stated
specifications. Signed under penalty of perjury
Date 6 z7 07
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