25C MARION RD - BUILDING INSPECTION What is the current use of the Building?
Material of Building? itdwelling,how many units7__--
Asbestos?
Will the Building Conform to Law?
Archited's Name 7 , a Z 2~9
Address and Phone
Mechanids Name
Address and Phone HIC Registration#
Construction Supervisors License#
Peit Fee Cak uiatlorr
Estimated Cost of primed S� rm
Estimated Cost X$71S1000 Residential
permit Fee S
Estimated CostX$41/51000 CammerGat—----
- — An Additional $5.00 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
�Peernit�d to the above stated
specifications. Signed under penalty of pedury x
Date
4
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CITY-OFgxr.F,�
PUBLIC PROPERTY
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1:150{FJILY Dvvvv
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130 W&WNCft*hrUsr 1 5MYJ4 X&%ACHLSk1-M 01970
It L 976745-9S"•FAn 97&7i0.990
APPLICATION FOR THE REPAIR RENOVATION N
CONSTRUCTIO
DEMOLITION OR CHANGE OF USE OR OCCUPAN FOR EXI TIN
STRU iQ OR BUILDING
1.0 SITE INFORMATION
Location Name: 6 Building; -�
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eny Address:-- --- -- — --- - - - - - _. . - -
.?s C ry'
Property is located in a;Conservation Area Y/N Hlstorio District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: _
Address:
Le,:OPHL-197,5188q. ap)
3.0 COMPLETE THIS SECTION FOR WORK IN 7Vstones
NGS ONLY
Addition g
Renovation ENumbeated
Change in Use Demolition gApproximate year of atedconstruction or renovationof existing building
Brief Description of Proposed Work:
rove ..emx pll--
---— -- Mail Permit to: jeo