2C DEWEY DR - BUILDING PERMIT APP JACKET Cmr oF- Em
PUBLIC PROPERTY
DEPARTMENT
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MAYOR 120 WASMN.WM sMEEr• -
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APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1A SITE INFORMATION
Location Name: , 7„„ eBuilding:
Property Address: �.
Property is located in a;Conservation Area YIN ' Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address:
Telephone: 7.�P- F 7-7
3.0 COMPLETE THIS SECTION FOR WORK IN EXISXINQ 13UILDINGS ONLY
Addition 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:
f / Lect� ✓'� Ile,� Ghat
The Chimney Guys
Poo 116A
Peabody,MA 01%0 -
-- Mail Permit to: — -
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Win the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone Peabody, MA 01960 ( )
978-977-9900
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Projed S oL Pertnil Fee Calculation
Permit Fee i Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 CiOrmmsrcW 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 a above
ststated
specifications. Signed under penalty of perjury � /[!/
Date
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