011A FILLMORE ROAD - BPA-07-696 C
PUBLIC PRQPERTY
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APPLICATION ORITHE,REP° REN YA x ON CONSTRUCTION F AIR. O TI
DEMOLPTION.OR CHANGE.04W)OROCCUPANCY._FOR. N Y EXISTING'
STRUCTUII:E.OR.BUILDING
i.o srTE INFORMA ON
Location Name: k L n JCV T-
SOL dM6 . Cggj
Properly isrbcated"in a:Conbervatlbn Arse YM Historic OlsUid YM
2A OWNER3HIP'INFOR"�'L ON
2.1 owner';ot Land
Name:.a r`
Address: f[1 f� Fi((iMor�,
QJrn. ` 0 10 .
Telephone: .
3.;t;MPLETE THIS SEC ON FOR-WORK IN E7PATrrurs �UILDINC;S.OtYLY
Addition I_ EziBting ` -
Renovation i Number of Stories Renovated
Change in=Use NeW`
Demolition
Approximate year ofAreaperfioor(sf) Reiiovated -
construction or renovation
of existing building New
Brief Description of Proposed Work:
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Mail Permit to: to to �- Mej rose- f 0 Z1 2 b
A4What is the current,use°of=the 8 ilding?•
MateriaPof Building? �+�`�"`
If dWeiling,how many units?
Will:the-BuitdhVg Conform to.Law?:, Astlestos?.
Archited's Name
Address and Phone � )
Mechanic'sName
Address and Phone-
ConsfteWn Supervisors Ucense 0HIC,Ftegistration if
Estimated°Cost of ProJed i RqS`'- Permit F wcalcuwli6h
Permit Fee-i— Estimated Cost X"IC 00'Residential
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An`Addltional$&Odis;added4s an
Mininiatretiye charge..
make sure that all fields are properhr and>legibly written to avoid delayean proceae_i'ng:
The undersigned does hereby apply fora Building�Pan"It'to build td:thh�e above stated
speciNcations. Signed under penaltyofipedury
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