1A FLETCHER WAY - BUILDING INSPECTION _ AMEN!_-_
PUBLIC PROPERTY
DEPARTINIENT
�ivaE�nsr o•R•-,+•
Mwvoa t3owwswNcra,N snircr
SMAK-M&stACHt:shl'R 01970
"nM.M71S M-0 FAX M740.96%
P I. 1� T^1
PL .
APICATION FORM REPAIR, RENOVATION CON TRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCr1p•ivrY FOR ANY EXISTING
STRUCTURR OR BUILDIN
1.0 SITE INFORMATION
Location Name Buiding
--
Property Address:- - - -
Property b bcated In a:Carsar dOn AM WN Historic D YIN
2.0 OWNERSHIP INFORMATION
4.1 Owner of Land
Name:
Address
/ fl Wit-., (�J�
Telephone: -7E -77 q,3(5
3.0 COMPLETE THIS SECTION FOR WORK IN EXISIt!irz BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building Now
Brief Description of Proposed Work:
e Uhimney uyS
P n Roy do74
Mail Permit to: Peabody, MA 01960
What is the current use of the Building? if dwelling.how many un'Rs?
Material of Building? Asbestos?
WiM the Building Conform to Law
Amhiteas Name
Address and Phone Peabody, 01960 ( )
978-977-99000(1
Mechanic's Name
Address and Phon• HIC Registration 0_------
Construction Supervisors Ucsnse tr
Estimatedof
Cost project i <��� Permit Fee Caiwistlon
Pertnil Fee i Of 0 d Estimated Cost X$7151000 Residential
- _ Estimated CoriX S11/S1OOO Commercial-----
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�P/ermit to build to�the
ababove stated
specftatkxw. Signed under penalty of Perjury
Date —7—�e�"
f
43
i
�I
0
N
N r >s
1l L r
4
06r-
- Y