R-170 LYNN ST - BUILDING INSPECTION (2) OVER BY T*IE
It T BFING GRANTED
�IT OF S EM
Date /0 3
Ward
\ Zoning District
Is'Propsrty Located In Location of �r -
b0lsibHc C1lstflot? Yea_No_ Building
f Rtapelty Located in
Ihi tonera'i allon Area? Yas No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, onstruct Deck Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications: ,l
Owner's Name /C 114M �� CDg,l,O /*1;Via.,,. LJ/161r.,.s ksd'
Address & Phone /h.�j (9,;?i 5-32
Architect's Name A�913X I'A) AsSaci aTs
Address & Phone /0 DA/S m oti.75{
Mechanics Name 7 C`o4 oS GOO d'✓c
Address & Phone �2 96. 1, AA,
�-
What is the purpose of building? /2r-4 "/,y 1 /0 s d Ara of
Mabrial of building?_6✓oaD Fit/9r>t17 If a dwelling,for how many families? 4v S
Will bullding conform to law? Z S ti Asbestos? A) 0
Estimated cost 3 •On-o ._cny uosnsa a state uow" it
Eaaa Impsovmnt
e' Si tore of Applicant
S 1+�.. 0'UNDER`THE PENALTY
q OF PtJURY,
'DESCRIPTION OF WORK Th BE DONE
In19 i,
72 5 a/a
(MAIL PERMIT TO: � ` � lj�'0 uro1 � — I
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