8 LOCUST ST - BUILDING INSPECTION (2) PUBLIC PROPERTY
DEPARTMENT
At%WFMXV DWSCULL
MAYOR IV WASMNG"Sir•SMrx MANUCHl ShTIS 01970
1VL•9'.&74S-9S"*RMc 976-740-98"
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: q /�„ ��, Building:
Property Address:
property is located in a; conservation Area Y Historic District
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name:
Address:
_9
Telephone; �P7cF— 7zy — 71 —6
3.0 COMPLETE THIS SECTION FOR WORK IN maziNr= BUILDINGS ONLY
Addition Existing y
Renovation Number of Stories Renovated
Change in Use New �j
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation f9�
of existing building New
Brief Description of Proposed Work:
�P`✓r U//t/� T/,l�cz r-es' U/fti cl �rnirs�f %A/ f'7llS'�1/� �•�`
* �(p✓ b : ✓CGS R /X %t'�/�GC'C'g lVe"
t1tl C
-_- _ -- Mail Permit to: fY UN '•><v F lbca s't
What is the current use of the Building? I-05 j06,oc fi
Material of Building? If dwelling, how many units?
Will the Building Conform to Law?5`{-s Asbestos? /Ud
Architect's Name 1�
Address and Phone d 1 l )
Mechanles Name t�73 kc
Address and Phone �� ��� 5' 1 E'Gi ti F77c• ttO Axel �CF�
Construction Supervisors License# C5 0,51 `-3 2.- HIC Registration# ///f3V
Estimated Cost of Project S `�' n� Permit Fee Calculation
Permit Fee$ Y Estimated Cost X$741000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are property 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 2
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