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1D FILLMORE RD - BUILDING PERMIT APP
�y What is the current use of<the•Bu ding? c, Material of Building? �p0 Ifdwelling; how:many units? . Will the Buiidinq Conforrn•to.Lave?. . Asbestos?' Archited's Nams Address and Phone�— 4L4 f ,O Machar►k a Name• :- � �-- � - '�/Y�P1�rc�SZ. _�vTi,"© z,t Address=andPhone t j j b I �JN`o Constriction Supervisors Ucense# CS3gg1 HIC::Registratfon# Estimated:Cost of Project S a� � Permit Eee.Cakxrlation Estimated Cost X 57/S100d•Residential a,nddfuor�af3s.00�s,added°�aar�- Administt(veoharge: Make sure that all fields are propery and Iegibly written to-avoid delay8 in,Processlnp, The undersigned does hereby apply fbrra,Building:Permit to build to,the abovestated specifications. Signed under penalty oUperjury raf7D a _ oj Jot i PUBLIC PRCp 'R`I'Y DEPAKM ; , 6 MAYor< 126Vir�sHiHeintl3`tu6t�:Scr�iiS4�LCc�nc #�7 `Itl$16, . 'tom:itys."►s5=9S95�,"��M7�'�`�`y�b-9lMF Antic 1 'ME READ —94, I1•;N6V�' 0 � C ATSTit�TLv' i� . DEliiOi:I'1'IDN� OIL C CE �P` SEt R bCCI�PX A�t_,E- S-1 C R.$UILD:O 1.QSITE INEORM%1 ON Loca.donName A.0 n -L. ProRertSr � tnno Property it kscated im a.eo atlan;Area YM^.,,...,tdiatorla OIs6�t Y1N 2.00WNERSl�IP IIVFOR �10'N 2.1 Owner'ot'Land Names l r/10v] CQl tV1 .Address:. 0 � D Tefepttane: ; 3:0.COMPLE78THM SEC7EIOtV.FCR11111�RktN' rr+�Tru Y UIl�IJI IiGS XhNGY : AdditionX18tirTg: Renovation -Numberof Stdrleh Rehovated Change"in u;te NIeMr� Demolition F_:iistin , Appd6iimate;year of ATea.p�r`floor(sf� . RerirdtpCJ cons'trucNon:orTenovation of sxisting;building Mid Description of Proposed Mork: Q ACC U 2> t irn (c�c—Fcb n (i�v L� 1 0� cV�3�g I W n L (ctpf _ 11r02� 1 _ . r a JC (}