_BUILDING EITY'OF AUENN
PUBLIC PROPERTY
DEPARTM&NT
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TEL 97L71i9S9!• �4 Y&UACHL PAX �tis 01970
APPLICATION FOR THE REPAIR.RENOVATION CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCLZANCY FOR ANY EXISTING
STRUC� OR BUILDIN
co SITE INFORMATION
Location Name: HuVcWwwoa /Y\C--Ji Col. Suiiding-
--- Property AddreSW- -- - ,
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Propsny Is located in a:Consa"*M Aroe YM HlsWft DZI t YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: 4{u�Cc�y meson eduCa�
Telephone: G7R- 2-65' CD 9>S -74.1 I��o
3.0 COMPLETE THIS SECTION FOR WORK IN EXISIIVNew
Addition Renovation Number of StorieChange in Use Demolition Approximate year of Area per floor (sf)construction or renovation
of existing building
Brief Description of Proposed Work:
F,." ,,t)' ��iOr w O� P� pia � s}�or�
/bo1 , Tu " c�eC,% .4P" 3 Sidga o rooms on�� . w u
s`A•s�e�rl�eA ce.�l k�, J�'C' Gloor- , book S�P.�vea Gv.r'
�� /C t�tic�,, Tr
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Mail Permit to: ►JPoc 's �J� ces . D.�o c 2823 lrJob..rn Nh9 01Seff
21` �,�a
What is the current use of the Building? 1.�p�r�ou
M m
dwelling,how any units? —
Material OF auk"? P —y 1�n�crtow n
WiY the Building Conform to Law? Asbestos?
Arahited's Name
Address and Phone
Mechanic's Name N A
Address and Phone 0 A -1
Su ,;acts License* O 39q 1 HIC Registration it
Estimated Cost�orf�Proj�ect: So Permit Fee Caleula M
Estimated Cost X i7IS1000 Residential
- _ Es*nated Cost X$111$1000 Commer iat--- --..
- An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly wMW 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 5 t IO-7.
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