6D HALSEY WAY - BUILDING INSPECTION CITY-Or S L —
PUBLIC PROPERTY
DEPARTMENT
1:1\WFRLEY DWSI'ULL -
MAYOR 120 WASHINGTnN SmEE-r 1
'-=h MAsu}+t;stllS O1970
141978-74S-9595#F=979.740.9846
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building: e n
-—- Property-Address:- -- --- —.- -
6-n /-M16e� ,9�
Properly Is located in a; Conservation Area Y/N A i Historic District Y/N A,1 _
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: 0r9vZ,0
Address:
se
Telephone: 7,3/- 6-96- V 717
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING_ 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 New
Brief Description of Proposed Work:
Mail Permit to: /0 30>1 e1--)?5'
What is the current use of the Building?
Material of Building? If dwelling.how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone G�� /�� S/o 76/
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ ���-� Permit Fee Calculation
Permit Fee$ — Estimated Cost X$7/$1000 Residential
— --- - -Estimated-Cost X$11/$1000 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 Permitto
build to the abovestated
specifications. Signed under penalty of perjury X_�
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