7 DEARBORN ST - BUILDING PERMIT APP (002) -CITY--OF LhN - -
' PUBLIC PROPERTY
DEPARTMENT
KISRIF.ILLEY DRISCOLL
MAYOR 120 WASHINcmN!"MEET•5AIAU4,%t.VSAC HlS61` S01970
TEL-978-745-959S*FAX 978.740-99" ^ '�
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION. V
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address: '� (fie/IiZ G3o�/� ST
S�/� /✓i/>1 a /77 v
property is located in a;Conservation Area YIN Historic District YIN /1—,
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
LAddress:
/Yf �e r✓ 'lam
cj $ -3
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 (sn Renovated
construction or renovation
of existing building New
Sri& Description of Proposed Work:
i -,)L) s %ave NsO�e?
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Mail Permit to: d'7
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What is the current use of the Building?
Material of Building? &4-J C O If dwelling. how many units? a Will the Building Conform to Law? S Asbestos?
Architect's Name
Address and Phone
Mechanic's Name ^'"�� /1 v u0�-�'"6�"�I % 'a s
Address and Phone 7
Construction Supervisors License# 07 B 7 HIC Registration#
Estimated Cost of Project Preectt oj $.�v Permit Fee Calculation
Permit Fee$W l�5_ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 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 lid to the above stated
specifications. Signed under penalty of perjury
Date of
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