36 ESSEX ST - BUILDING PERMIT APP PUBLIC PROPERTY
DEPARTMENT
K1.N47ERI.EY DRISCOLL
.MAYOR �> 120 WASHING TON STREET• SALILK A1SACHLSLIIS 01970
lei 97&745-9595♦FAX:97&740-9W
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION
DEMOLITIO_N_, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: 36 £ss,e,Y S"7` Building:
I' Property Address:
Property is located in a; Conservation Area YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land L,14,1
Name: G ,�.�a!4 C-4 �, r�
Address: 3G ss &>r 3 f
Telephone: 970'-4rz_ 795
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation v/ Number of Stories Renovated
Change in Use New
Demolition �— Existing T
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
l/ldresvaTe ., 7�f%jAL
Mail Permit to: r�
r
What is the current use of the Building? 2 )Gr A. 2
Material of Building? F/>x" 'L If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architects Name IV14
Address and Phone
Mechanic's Name
Z 36�
Address and Phone 28 `
Construction Supervisors License#
CS 06/ 33 HIC Registration#
Estimated Cost of Projec$�✓ Permit Fee Calculation
Permit Fee $ /O S� Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$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 stated
specifications. Signed under penalty of perjury
Date
al
6 0
F V d
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