2D FLETCHER WAY - BUILDING INSPECTION (003) EI'IYOF& Lmp
y PUBLIC PROPERTY
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APPLICATION FOR TM REPAIR. RENOVATION. CONSr>Qrrrr M,
DE,HOLITION.OR CHANGZ OF USE OR 0M MCI& FOR ANY Z3Lv q
S'ilci Ligt OR H>Lm n>ntsn
1.0 an INFORMATION
Location Narm suWilrw
--
RopwV Is located in a;Conservation Am YIN rJ Hlsloda Dk M YM
M OWNERSHIP INFORMATION
2.1 Owner of LoW _
Name•.
Addreea:
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ff
THIS SECTION FOR WORK IN E711S7 Wti BULDIN08 ONLY
Existing Number of Stories Renovated
Change In Use New
Demolition Existing
Approximate year of Area per floor(sQ Renovated
construction or renovation
of existing building New
adef Description of Proposed Work:
--- -- ---Mail Permit to: - - -
I
What is the uunnl use of the Building?
Material of Buidkg7 if dvwNkq.how many unils4
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Arot�ksrXa Nafrta P.O. Box 40i4
Peabody, MA 01960
AddrGW and Phww - _
Mechmnles Name
Address and Phtxw HIC RepMtra6on 8Conatruclian 8upwvmm Ucente S
Estimated Coen of P►ojad e / , 9s" Pam FN CalaYatlon
Penn t Fee S Es*natad Coat X$7151000 RNIdaMial
Ex*naLad Cant X S4111111000 CcmmarcW An AddNkmd$6.00 is added as an
Adminb&Wve dwg&
Make sun that all Holds are Properly and ►eyibly witten to avoid delays In Processln0.
The urdamipnod do"hereby apply for a SuUdIng Pwn*to tw dw alwve
Signed spscMcsdcne. under Penally of pwjury
Date d
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