286 ESSEX ST - BUILDING PERMIT APP EITy-o�g� ---
PUBLIC PROPERTY
DEPARThIFNT
KISS FJ"oeracuu.
�t.roe 130ww9uHc nW!ftMr•SMEKMALSAClIMrR 01970
TW 976.745-MS•PAM 976740.9"6
APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION.
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY MSTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION J
Location Name: Building:
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:
n
Telephone: / -
3.0 COMPLETE THIS SECTION FOR WORK IN EXIS I G BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work: / /
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What is the current use of the Building?
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Material of Building? o` if dwelling.how many units? "
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Wilt Ups Building Conform to Law? es Asbestos? N e
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Arch-dads Name
Address and Phon0 / ( )
Mechanic's Name S ��� ��^ /�'n�nn (L d e - /
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Address and Phone 7 z c
CWjction Supervisors tense# 5 JI L�j HIC Registration#
Estimated Cost ojed �aa, c� Perrnk Fee Cakwlatioo
Permit Fee Estimated Cost X$7/51000 Residential
Estimated Cost X Si l/Sl000 Commercial---
An Additional $6.00 is added as an
Administrative charge.
Make sure that all fields are property 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 � d,
I
N
a R s a
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