7C FILLMORE RD - BUILDING INSPECTION — —; EIT`Y-OF-S-. ETr—
PUBLIC PROPERTY
DEPARTI4IEINT
MAYM 120 WASMNG M!`I7F1,T 0 '
may.NtiSaOMStllS 01970
TEL.91&74S-9S"•FAx 979.740.98"
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR RUH.DING
1.0 SITE INFORMATION
Location Name: C _,,� Building:
Property Address. — �/+ ,o 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:
Telephone: 4 p— 9 7 Z --q 4 zTv
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation X, Number of Stories Renovated
Change in Use New.
Demolition Existing
t
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
/Le.� tLe cq�5 /2z.n /lam
The C
P.O. Box 4074 -
-- - — ---- --Peabody, ---- -
Mail Permit to: - 97x_09900
I_
What is the current use of the Building?
Material of Building? If dwelling.how many units?
Will the Building Conform to Law? Asbestos?
The Chimney Guys
Architect's Name
Address and Phone n h a�, i14A OJ 960 —j j
Mechanic's Name 975-971-9900
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project Permit Fee Calculation
Permit Fee S Estimated Cost X$7/51000 Residential
Estimated Cost X$11/51000 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 ve stated
specifications. Signed under penalty of perjury X
Date-- sO
ti
F Z O U 9 r
CL06
6 v