65-67 ENDICOTT ST - BUILDING PERMIT APP 1
PUBLIC PROPERTY
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MAYOR I20 WAsmNGTON 5T8FFr 0$MXK WA.%SAAcHLsvrrs 01970
TEL 978-745-959S 0 FAIL 979-740-9846
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address:
6 s- 6 2 cNe/c4 77- Jr
property is located in a; Conservation Area YIN A_Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: pLGv/I j,V fA/ - _AJ 0 619T/oV
Address: (S • 67CA-/P /wT7- sT
Telephone: Vx- 00v
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
— -- Mail Permit to: A6yiJ/dfANCi &Wk 4-ffO G�=67C-141617 Si ski 01S70
What is the current use of the Building? (0A),J0 r
Material of Building? typo C( If dwelling. how many units? L
Will the Building Conform to Law? y� Asbestos? NU
Architect's Name
Address and Phone l )
Mechanic's Name OKQ �o r
Address and Phone 37 R a
Construction Supervisors License# Cj Z`i (o o HIC Registration#
Estimated Cost of Project$ 5 000 Permit Fee Calculation
Permit Fee$ y 9 Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
/ Administrative charge.
y� 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 stated
specifications. Signed under penalty of perjury /�
Date
N /
4\ J
YY
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G 96