1B HALSEY WAY - BUILDING INSPECTION (2) What is the current use of the Building?
Material of Building? if dwelling,how many units?_—
to Law? Asbestos?
WIN the Building Contorrrr
The Chimney Guys
Archited s Name oa
Address and Phone ( 1
Mechanles Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Pro-ad S�1P. 0-6 PermitFee Cftkdon
Perrnit Fee i Estimated Cost X$71S1000 Residential
----- -- _._. __ EstlmaW Cost X$I1/$1000Commm►clal -------- - -
- An Additional S5.00 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 b the above stated
specdIcatlons. Signed under penalty of perjury
C
Date
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EITY-OF-i, -
PUBLIC PROPERTY
DEPARTMENT
AP—rll
NIA t:-sR.3 t,lifn<< 1 �s1p
130W%WiG !,k'nLwr• ,,.K yMUOiL,5h1 S01970
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APPLICATION FOR THE REPAIR ,RENOVATION CONSTRUCTION
DEMOLITION.OR CHANGE OF USE OR OcOMA-sm FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location NNW. / Building:
Property Address:- -- -- - - -- -- - - -- -- -- - - -
Properly is k)=W In a:Conservadw Area YIN 2� Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: )
Address:
Telephone: Zd�-2 ��- �
3.0 COMPLETE THIS SECTION FOR WORK IN EXIBIINQ BUILDINGS ONLY
Addition Existing
Renovation Number of Stories E.New
ovatt I
ed
Change in Use
Demolition Existing
Approximate year of Area per Floor(so Renovated
construction or renovation
of existing building New
B&J Description of Proposed Work:
The Chimney Gays
_P.O. Box 4974
Peabody,A4A01960 --
Mail Permit to: 78_977_99Flo
li i