7B FILLMORE RD - BPA B-2008-318 EITytOF
PUBLIC PROPERTY
DEPARTMENT /�
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(FOR THE REPAIR. RENOYATION. CONSTRUCTION.
DuMOLITIOM OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING_
STRUCTURE OR BUILDING
1.0 SITE INFORMATION J
Location Nome: Building:
Property is located in&:Coraervadon Are&YIN Historic t)lehlot YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: `7—s f c/
Telephone: q
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Extating
Renovation Num
ber of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area er floors R n Y p ( e ovated
n
construction or renovation New
of existing building
FLdd Description of Proposed Work:
The Chimney Guys
P.O. Box 4074
eabony,
----- --- 978 977 9900 - — - - -
Mail Permit to:
What is*0 parent use of the Building?
Material of Building? M 'how e
Wil the Building Conform to Asbestos?
oss??
Architeds Name
Address and Phone Peabody,MA 01960 j
978- -
Mechanic's Name
Address and Phone
Construc*M Supervisors Uceenssee 0 HIC Registration 0
Estimated Cost of Projed 0. Permit Fee Cakulatlon
Permit Fee i Estimated Cost X 11741000 Residential
Estimated Cost X$41/$1000Cornmercial---------__ - - -
An Additional$5.00 Is added as an
Administrative charge.
Make sure that all fields are Properly and legibly written to avoid de/lay/s in processing.
The undersigned does hereby apply for a Building Permit to byl jtd the above stated
specftatlons. Signed under penalty of perjury /� ✓2 C/
Date S
F,
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