3A FILLMORE RD - BUILDING PERMIT APP CITY-OF
PUBLIC PROPERTY
DEPARTMENT
ORISCML
"uak 4weAart:sek'R 01970
MM.97e•74&9M i FAi W&74098N
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR WELDING
1.0 SITE INFORMATION
Location Name: V�C,� Building:
Property Address--- - -- - - - --- � �- -- -- ------ -- -- - _. . .-- - -- --
Property Is located In a;Conservation Area Y/N�L_Historic 1-W- t Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Z' ^
Address: 3�J 7 7�//ram o•�
Telephone: ^77- Pp�
3.0 COMPLETE THIS SECTION FOR WORK IN EXI LTMG BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Nay
Demolition Existing
Approximate year of t
er floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
The imuey Guys
-.. -- —Peshud 1VL4 6T9b0.. - - - - --
- ------Mail Permit to: 978-977-9900 - - -
What is the current use of the Building?
Material of Building? it dwelling,how many units?-
"a the Building Conform to Law? Asbestos?
The Chimney Guys
Architeds Name ox
Address and Phone
Machanie s Name -
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Projad S � Pemhit Fee Cakxulatbn
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/A1000 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 as above
stated
specifications. Signed under penalty of perjury X
Date �
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