225 LAFAYETTE ST - BUILDING INSPECTION (2) c PUBLIC PROPERTY
DEPARTMENT
KimamEY 13RLSCOLL
MAYOR 120 WASHINGrON S MU•&U.E r,%L%AAa4;S#-XM 01970
. 'ML-97&74S-959S♦PAM 97&740.9S"
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:
Property Address: -2 S Z r¢Fi4�vo7I`� $7
L v4[
Property Is located in a;Conservation Area YIN A_Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address: gr y ,W� �
Teleptrone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New �—
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation /°J�3
of existing building New
Brief Description of Proposed Work:
>0
Mail Permit to: '�'
What is the current use of the Build' g? � lU �
Material of Building? ✓o 'f/ I� f dwelling, how many units? ,S
Will the Building Conform to Law? y4AJ Asbestos?
Architect's Name
Address and Phone
Mechanic's Name ls S
J "I
Address and Phone Coi� � Y� r�t�N �rS �
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$�� Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$1141000 Commercial
An Additional $a.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 bull jto a s
specifications. Signed under penalty of perjury
Date
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9
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Crry OF SAmm
' PUBLIC PROPERTY
DEPARTMENT
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