R-170 LYNN ST - BUILDING INSPECTION (3) 11R,It
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OVER BY T+IE
IIQR .D F T BEING GRANTED
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tIT� OF S, LEM
Date �0 5
i
Ward
Zoning District
Iri:';Property Located In Location of
'��a Hlstbito DWdct? Yea_No_ Building
14 P�lpparty Located In
i 44onse'Ivatlon Area? Yee 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:Owner's Name
,,11£ h n 2
Address & Phone �/�an1.J�,�SH'r/,O.rnr� ( 29 5-32
At chitect's Name ��IC43XI'P.) ASSdci�9Tes
.Address & Phone /On/smow75{ N l t
Mechanics Name
Address & Phone l O AAnJ s /fA,Oo i�6} � ' S 31' fL r-
What Is the purpose of building?
Material of building? GJaDO 1�FAa-- r q If a dweAing, for how many families? / G,
Will building conforrn to law? r 1's Asbestos? 0 �f/l
Estimated cost 36. Gty ucense r State Ucansa a �7 7
Hsu Lupsovemsent
Lie. lure of Applicant
1N �.WfVpEr� THE PENALTY
OF PRIURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: J li?O USA� _ I
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