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27D MARION RD - BUILDING INSPECTION (2)
CITY-OFrSXLEb - PUBLIC PROPERTY DEPARTNIENT Kl.�tsY DILSCIV b �(wval 120 WA9UN W 3'rULT•Sn1&r,YANACHL TM 01970 I'm 97e.74!69"S•FNc M740.9W APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION, DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR RUH.DING 1.0 SITE INFORMATION Location Name t3uild(ng; Property Addreas:-a -- Property Is located In a;Conservation Area Y/N Histaft Disbtat YIN 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: tA Address: Telephone: `)FS -7`1 0C) 3.0 COMPLETE THIS SECTION FOR WORK IN E7CISIINLi BUILDINGS ONLY Addition Existing Renovation t,-"' Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building I I I New Brid Description of Proposed Work: —- - ---Mail Permit to: © d-2VIQ II -_ What is the current use of the Building? Material of Building? If dwelling.how many units? will the Building Conform to Law? Asbestos? Architects Name ! Oir,�o �?8 L} 7-7 Address and Phone cc) �'G Mechanic's Name Address and Phone Construction Supervisors License 0 HIC Registration 0 Estimated Cost of Project$o?� Permit Fee CalcukdW Permit Feall Estimated Cost X$71$1000 Residential Estimated Coat X$11/411000 CommercialAn 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 uUd to the above stated specifications. Signed under penalty of perjury Date 9 c?6--42 0`7 N s 9 os `o