007D FILLMORE RD - BPA-08-305 CrrroF
PUBLIC PROPERTY
DEPARTMEINT
KINMER ar osacwi.
%IAVM 137 wtivuuw W!1iM r•eUAiK MuuaLStrs 01970
147_M745-9S"0 PAX 970.740.9810
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:---� ---
Property le located in a:Conservation Arse YIN -J HlsW1c DlsMct YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone: F 7 7— 9 9 d v
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use N.
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
&ief Description of Proposed Work:
/ate C� Cc- C'ov C�orCo � ✓cc�
J
The Chimney Guys
- — ---Peabody,AIAA1960 --- --
Mail Permit to: 97
What is the current use of the Building?
Material of Building? It dwelling.how many units?
Asbestos?
Win the Building Conform to Lave
Architect's Name 4 Peabody, 74
Address and Phone
MA
Mschanids Name
Address and Phone
Constriction Supervisors Ucense# HIC Registration#
Estimated Cost of Project G0 Permit Fee Calculation
Permit Fee i Estimated Cost X$7/$1000 Residential
Estlmated CostX S411$1000 Carmnercia4---------- - .. . .. . _
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build a above slat
specifications. Signed under penalty of perjury X
Date 6 b
N i
3
'v N
2 9 r.
F a
L o-_._