1 KERNWOOD ROAD - BUILDING INSPECTION EITrorg -
PUBLIC PROPERTY
DEPARTMEINT
SAt04 WMAQilStll3 01970
Tn.MUS-MS•FAx 976.740.9eK
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: er-n wcv C/ _ Building: c ��
property Address.
Ve, tam Lvt�vd o
Property is located in a; Conservation Area Y/N HWAft District YM
2.0 OWNERSHIP INFORMATION ��
2:1 Owner of Land 7,71"
L /�
Name: / /-^'l L oc� (�r7� Do
Address:
Ole, ��,� J
Telephone: S-
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition g
Renovation �Op` Num77j
ated
Change in Use
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
add Description of Proposed Work:
---Mail Pemtit to: , oZ/ �/ X04` f,�G7,h /0 Ole07
What is the curtent use of the Building?
Material of Building? /i'�'� If dwelling.how many units? —
Wifi the Building Conform to Law? �
Asbestos? °
p rchnect's Name
Address and Phone ^ /J LLC
/�Wil' /�J/�GCG �Jp/�yC. iii ��ll +din
Mechanic's Name /401 O/Q77 7d'/ S3g9 /'f O
Address and Phone �/ E/^ '-`e S �J
Construction Supervisors License 42y Da-0?' HIC Registratbn fl �U3 61 y
Estimated Cost of Project
$_24 a� permit Fee Calculation
Permit Fee: UO Estimated Cost X$7/$1000 Residential
— - - --- ---- Estimated Coet X$11/$1006 Commerclat---
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
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