013C FILLMORE DR - BPA-08-662 What is the current use of the Building?
Material of Building? if dwelling. how many units?
Wig the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone afv a �to��f �:°� �o ✓�/'�� dl9�v 92 i� �¢ a"
Construction Supervisors License M HIC Registration#
Estimated Cost of Project 5 / 6a, Permit Fee Cakx WOVI
Permit Fee$ 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 b the above stated
specifications. Signed under penalty of perjury
Date
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a �s
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06 a
EITrOF&ALEM
PUBLIC PROPERTY
DEPARTINMINT
,:I.mENLEV 0RMX) .
MUvoa 120 WA-%UNG w snEEr
5'-Uk NnSteoHL5ti1S 01970
Tu--976.7454S"• FAX 975-740-98"
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCOZA—N-CYA FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address:/_7._G
Property is located in a;Conservatkxt Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: /� G fr�slln�6rt C
Telephone:
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
of existing building New
Brief Description of Proposed Work: /
Mail Permit to: l mkt