1A HALSEY WAY - BUILDING INSPECTION (2) What is the current use of the Building?
Material of Building? if dwelling,how many units?— ____--
Asbestos?
Will the Building Conform to Law?
Archited'sName O o u �_/�. ),•ilia �
Address and phone
Mechanids Name
Address and Phone HIC Registration M
ConsUucom Supervisors License S
Estimated Cost of Pro d S Pem�A Fee C"istion
P�+f Estimated Cost X$71$1000 Residential
Permit Fee S 5� 1—
_- Estimated Cost X S111S1000 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 Permit to build to the above stated
specifications. Signed under penalty of perjury
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PUBLIC PROPERTY
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130WtivurwTc,Na iT SALLK
MAUAan;st„s01970
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTIN
STRUM OR BUILDIN[`
1.0 SITE INFORMATION "
Location Name: Building: A
-- Property Adckess:---
L
Properly(s boated in a;ConservatioHletario DWtrld YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Q
Address:
I/I ( , -)
Telephone: 91a -7 y5 a
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation L/ Number of Stories Renovated
Change in Usb New
Demolition Existing
Approximate year of Area per floor(so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
--- -- -- Mail Permit to: