27C MARION RD - BUILDING INSPECTION (3) EIT` -oF-S C _ -
PUBLIC PROPERTY
DEPARTMENT
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To-97e.745-gS"•FAX M7404M
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: � vr^ roc, Suitdtng:
— -- - Propeny Address a,-- - --
Property is bested in a:Conservation Area YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.f Owner of Land
Name:
Address: a--c C
Telephone: Ott
3.000MPLETE THIS SECTION FOR WORK IN EXLgX G BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use NOW
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
- --- Mail Permit to: 0 wo
What is the current use of the Building?
Material of Building? Ifdwelling.how many units?
WIN the Building Conform to Law? Asbestos?
Architect's Name 1
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Proje Ste' Permit Fee Cak ulatlon
ct
Permit Fee S Estimated Cost X$7/51000 Residential
- - - .- - - — Estimated Cost X S41/411000 CormrnewAat---------- - -
An Additional $5.00 is added as an
Administrable charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to b ild to the above stated
specifications. Signed under penalty of perjury X
Date
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