11C FILLMORE DR - BUILDING PERMIT APP EITY OF�XLE� --
PUBLIC PROPERTY
DEPARTMENT
KOMERIEY DR15COLL " - .. •.
MAYOR l3o WAsmNcTnN STRFBr*!sAu*%AAAcrostT6Ot970
'7'Lm 9?9-7.45-959S*FA]497&740-98"
APPLICATION FOR THE REPAIR, RENOVATION CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
rSITEORMATIONe: Building:
ess: jl_Clocated in a;Conservation Area Y/N Historic Diatrid YIN�_
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
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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 (sf) Renovated
construction or renovation New
of existing building
Brief Description of Proposed Work:
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The Chimney Guys
P.O.Boa 4074
Mail Permit to:
What is the current use of the Building?
Material of Building? If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name P.O. Box 4074
Address and Phone Peabody,MA 01960978-977-9900
t
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ c Permit Fee Calculation
Permit Fee$ CZ2:5L — Estimated Cost X$7/$1000 Residential
Estimated Cost X$111$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 Permitto build to a above stated
specifications. Signed under penalty of perjury X
Date Z
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