11C GRISWOLD DR - BUILDING INSPECTION CITY OFr ',
PUBLIC PROPERTY
DEPARTMENT
130wwyuraGTM Sneer•sAUiK wssna;skrs m97o
'M.M743-""•FAZ M740960
APPLICATION FOR THE REPAIR RENOVATION, CONSTRUCTION.
D&MOLTTIOM OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: 4 .,J ! Building:
----. .. Property Address
Property Is located In a;Conservation Arse Y/N Historic District YIN
2.0 OWNERSHIP INFORMATION
2.i Owner of Land _
Name: C. �i✓h P/2
Address:
Gars w�
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EYISS1NLIt BUILDINGS ONLY
Addition Existing
Renovation V Number of Stories Renovated
Change in Use Now.
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Bdef Description of Proposed Work:
Ole
Mail Permit to: &fy 5�/ rn o t o
What is the current use of the Building?
Material of Building? If dwelling.how many� ?
Win the Building Conform to Law? Asbestos? --
s9 -
Architeas Name f
Address and Phonta OPC^
IMeehanW*Name
Address and Photo
Construction Supervisors Licence 0 HIC RegistratConstruction
Estimated Cost of Projed i Pemdt Fee Calculation
Permit Fee S EstYnated Cost X$7151000 Residential
Esymatad cost X$11n1000 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 the above stated
specifications. Signed under penalty of perjury
Date
xi
x d
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