15A FILLMORE RD - BPA-08-657 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
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project S 1 Permit Fee Cftlation
Penult 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 build to the above stated
specifications. Signed under penalty of perjury X
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DEPARTMENT
AINGWRLEY DUSCOU.
MAYOR 130 WASMNG"hrREEr 1
5"uLK MAssnarLsILis 01970
Tm-976745-Mg • FAx 97s•749su
APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address. /6-R „ /�
Property is located in a.Conservation Area Y/N /Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: V _ ^
/5'/9 X o- ( /
Telephone: lq-79' 43-)_? 4qq00
3.0 COMPLETE THIS SECTION FOR WORK IN E7fta i Nra 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 NOW
Brief Description of Proposed Work:
Mail Permit to:
r.