43 DUNLAP ST - BUILDING INSPECTION JACKET 'y: EITY-OFFAL -
PUBLIC PROPERTY
DEPARTMENT
KIMERI.EY DRISCOLL
MAYOR UO WASHINamN S7REEr# -
LAI 1:K MAj5Actit;st1'rs 01970
1Et 978-745-9595 *FAx:978.74G-9846
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: OJ LAf-f' Building: f dCV C
Property Address:
Property is located in a; Conservation Area Y/N Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: Lf PUS ` '7�1'0 0 t
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXI.S NG BUILDINGS ONLY
Addition Existing /
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sq F
ovated
construction or renovation
of existing building
Brief Description of Proposed Work:
Sh l�, ��Cle *,t.j
CHI44vd /ecbv4
Mail Permit to:
What is the current use of the Build' 7 g E5S d4j C'2, r .
Material of Building? p o If dwelling, how many units?
Will the Building Conform to Law? Ile _ Asbestos?
N �
Architect's Name
Address and Phone t
Mechanic's Name �fz
Address and Phone
Construction Supervisors License# ®alp 2`f HIC Registration#
Estimated Cost of Project$ -5-00 +`9 13 Permit Fee Calculation
Permit Fee $ � Estimated Cost X$7/$1000 Residential
Estimated Cost X$111$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 to build to the above state
specifications. Signed under penalty of pedury
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