5 HODGES CT - BPA-2007-90 REMODEL 3 K&B'S -CITY-OF SALE
PUBLIC PROPERTY
DEPARTMENT
KINMERLEY DRISCOLL
MAYOR 120 WA-SHINGTON STREET♦SALEK MAS&ACHLSLITS 01970
TEL-978-745-9595* FAX:979-740-98"
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: •e oc ti Building:
Property Address: A�� \ V�A+, C-�.
Property is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land ems.
Name:
Address: �—
t
Telephone: O�-
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 B Area per floor (sf) Renovated
construction or renovation ti s `�
of existing building o New
grief Description of Proposed Work:\ ��`s1• �4�` t S �� ��M,�
w.Q.� ����ls.:,�s � moo..,-.s ��+• •,,� � �4�,�
Mail Permit to:
What is the current use of the Building?
Material of Building? `• oo-Z .n If dwelling, how many units?
will the building Conform to Law?
S Asbestos? N O
Architect's Name
Address and Phon
Mechanic's NameR
Address and Phone i-7 0 `40 -5—
Construction Supervisors License# ` HIC Registration#
Estimated Cost
��ofPr��oj��ecctt$ O 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 Permit to build to the above stated
specifications. Signed under penalty of perjury
Date ����(� C
� S N
Ira
o rN,