4 LARCHMONT RD - BUILDING INSPECTION (2) EIT7f-OF
PUBLIC PROPERTY
DEPARTMENT
A_*PLCATION FORT= RE*AM RR_rOV&UQ r_ON"RUCTION_
DID401 I'IM OR CAANGZ O/USS Olt OCCU*_ N['V_ w.R AN FYisMG
�UCRJAZ OR BUIi.Dalil'i
1.0 SIn INFORMATION .
Locadon NWM L 20
y Z-9,eC.PlAi aNT �t d
Propsrq is boded in a;Consnva0on Are@ YM Al HaMft OWWd YM ti
2.0 OWNERSHIP INFORMATION
9.9 Owrw of Land _
Kama AAALEEXI . A a s S
Addnas: q L4QcWA,&NT k6
Telephone; 979. 7Y-r- 7/87
s.tl COMPLETt THIS SECTION FOR WORK IN E7ltfl M BUILDINGS ONLY
Additlon Exlstlng
Renovadw FArez
r of Storks Renovated
Change h Use New
DernoUdon �Wy�
Approxinste year o/ r floor(sQ Renovated
constructlon or renovation
of exisWV building New
add Descdpdon of Proposed Work:
--- -- ---Mail Permit to o
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