6 E COLLINS ST - BUILDING PERMIT APP JACKET EIT�OF
PUBLIC PROPERTY
DEPARTMENT
Y.I%amd ONSW
�ra 1�1DASlIITILIIIU��168! SMby,Yw'ftAGi4:Skl'R 01970
APPLICATION FOR THE REPAIR RENOYATION_ CONSTRUCTION,
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY. FOR ANY EXISMG
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
PropeRy Address - -- - - - -- - - - - -
Z� E�/s�Gvu.�tis s
Property i.locoed in a;Cwwwvation Ar@ YM Hkdorlo okokS YM J1
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land �, ,vim
Name: 7 .cJcLC
Address:
Ted:
3.0 COMPLETE THIS SECTION FOR WORK IN MaSIING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change In Use Now
Demolition Existing
Approximate year of Area per floor (st) Renovated
construction or renovation
of existing building New
Bdef Description of Proposed Work:eezcode- /'-<s7w GlA3cj D.vc% a(f
�xjih�P wy �.Us �C4, /Vew� vinAc �c ce�ic�ci••+� Fu✓J cc 9Bof
----- ---Mail Permit to: .vcc� s7c.,cc.,cu sT S,9c�-e o�s7�
What is the current use of the Building?
Material of Buiiding?4e. � M dwelling.how many units? 4&
Will the Budding Conform to Law?-' Y."1 Asbestos? n
Archdoot's Name
Address and Phone
Mechanic's Name
Address and Phone
Construction supervisors License ar __ HIC Registratbn N
Estimated Cost Projsd i_i Permit Fee Calculation
Permit Fee S Estimated Cost X$71$1000 Residential
Estimated Cost X i411:1000 C mmwclm t— -- --
G , -O An Additional$5.00 is added as an
cv{�C Administrative charge.
V( Make sure that all fields are properly and legibly written to avoid delays In processing.
The undersigned dose hereby apply for a Building Permit to build to the above stated
itle specationa. Signed under penalty of perjury X—
Date �� 0
N i
a
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