2 ELM AVE - BUILDING PERMIT APP CITY OF- -
' PUBLIC PROPERTY
GO DEPARTMENT
IGwcn cv DRISCIriJ.
%IAVM 130 WAWNGWW a`nF"•SAUK wssA04L.st„s 01970
TH--M745-9S"•FNC M740-9M
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
co SITE INFORMATION
Location Name: S Building:
-----
Property Address _—
Property Is boated in a:C mwvatlon Ares Y/N Historic Diablo Y/N
I 2.0 OWNERSHIP INFORMATION s
2.1 Owner of Land
Name: S ro s�! /
Address.
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN MUSMM BUILDINGS 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
EL&I Description of Proposed Work:
r0e,e o s�
------ ---Mail Permit to:
What is the Current use of the Building?
Material of Building? If dwelling.how many units?
"a the Building Conform to Law? Asbestos?
ArcfirtecCs Name�_-60
--.�
Address and Phone —� � Q ✓M )._.
Mechanic's Name
Address and Phone _
Conglruction Supervisors license# —HIC Registration# 3 S
Estimated Cost of Project i O Pw mk Fee Calculation
Permit Fee i Estimated Coat X$7Ii1000 Residential
Estimated Cost X$411$1006 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 t e abo ie stated
specifications. Signed under penalty of perjury
Date
N
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